CT监控下立体定向颅内血肿抽吸术的临床应用

Clinical application of CT-controlled stereotactic aspiration for intracerebral hematoma

目的 探讨在CT监控下立体定向脑内血肿清除术的临床应用价值。方法 将定向仪安装在CT床头侧并与CT坐标中心校验为同步 ,病人在手术室或直接在CT室钻孔 ,手术全过程在CT床上进行 ,至少行术前、术中和术毕 3次监控扫描 ,并根据需要随时扫描观察动态效果或调整靶点。本组共 86 0例 ,包括基底节血肿 40 8例、丘脑 内囊后肢血肿 136例、外囊血肿 10 5例、脑叶血肿 15 6例、脑干血肿 40例、小脑血肿 5例及脑室出血 10例 ;抽吸术距发病时间自 3h至 14d。结果 血肿可随意抽出者 5 86例 ,血肿较馥稠但可清除率大于 5 0 %者 2 0 2例 ,可清除率在 5 0 %以下者 6 8例 ,完全无法抽出 4例 ;手术时间 2 5～ 12 0min ,平均 45min ;存活 6 93例 ,死亡 16 7例 ,对生存者进行日常生活能力测评 (activedaylife ,ADL) ,ADL 1～ 2级者 378例 ,ADL 3级者 16 6例 ,ADL 4级者 10 7例 ,ADL 5级者 2 8例 ,失访 14例。结论 CT监控下立体定向脑内血肿抽吸术 ,是 1种值得推广的安全、精确和简捷的脑内血肿治疗方法。

Objective To evaluate the clinical application of CT-controlled stereotactic aspiration for intracerebral hematoma. Methods CT-guided stereotactic system was installed on the CT bed, and checked against a standard of the coordinate. According to controlled CT scan, the target can be adjusted at any time in the operation. 860 patients with cerebral hematoma underwent CT-controlledstereotactic aspiration. Of the 860 cases, basal ganglion hematoma was present in 408, thalamus and posterior limb of internal capsule hematoma in 136, cerebral lobe hematoma in 261, cerebellar hematoma in 5, ventricular hemorrhage in 10, midbrain and pons hemorrhage in 37, and medulla hemorrhage in 3. Results Easy drainage of hematoma by aspiration was achieved in 586 cases, stickiness of hematoma with clearing away more than 50% was performed in 202 and less than 50% in 68. The operation duration ranged from 25 to 120 minutes (average 45 minutes). 693 cases survived and 167 cases died. According to the evaluation by active day life (ADL) after 3 months in survivors, ADL 1-2, ADL 3, ADL 4, and ADL 5 results were achieved in 378 cases, 166 cases, 107 cases, and 28 cases, respectively. In addition, 14 cases were lost beyond recall. Conclusion CT-controlled stereotactic aspiration for intracerebral hematoma is a handy, less invasive, and safe procedure with high accuracy and curative effect, it is worth while popularizing the procedure.