双靶点微创治疗丘脑出血破入脑室并发脑积水

Minimal invasive therapy at two targets for thalamic hemorrhage with entering into the ventricle and accompanied by hydrocephalus

目的探讨高血压丘脑出血的微创治疗方法。方法回顾性分析10例高血压丘脑出血破入脑室伴脑积水的病例资料,采用已取得专利的立体定向微创器械,以双靶点软通道微创穿刺引流,同时行丘脑血肿和脑室微创穿刺引流,术后辅以尿激酶灌洗治疗。临床评价标准包括血肿清除率、脑积水缓解率、手术时间、术后再出血、颅内感染率、30 d病死率及术后随访1-24个月GOS。结果术后病人平均血肿清除率为（90.0±1.6）%,脑积水缓解率90%,平均手术时间（25.6±4.8）min,无血肿腔再出血,发生颅内感染2例,30d病死率10%。术后随访1-24个月,GOS5分3例,4分3例,3分1例,2分1例,1分2例。结论双靶点软通道微创穿刺引流治疗丘脑出血破入脑室伴脑积水具有操作简单、安全、有效、创伤小的特点。

Objective To explore minimally invasive treatment for hypertensive thalamic hemorrhage. Methods Clinical data of 10 patients with thalamic hemorrhage with entering into the ventricle and accompanied by hydrocephalus were analyzed retrospectively. All the patients were treated by special minimally invasive stereotactic devices. The patients were given bilateral puncture drainage at the thalamic hematoma cavity and lateral ventricle, followed by instillation of urokinase. The clinical evaluation included hematoma evacuation rate, hydrocephalus relief rate, the mean operation time, rebleeding rate, infection rate, 30-day mortality rate and postoperative GOS was followed up for 1-24 months. Results The hematoma evacuation rate was（90.0 ± 1.6）%. The hydrocephalus relief rate was 90%. The mean operation time was（25.6 ± 4.8） min. There was no rebleeding patient at hematoma cavity, but two patients suffered intracranial infection. The 30-day mortality rate was 10%. During 1-24 month follow-up, GOS was 5 in 3 patients, 4 in3, 3 in 1, 2 in 1 and 1 in 2. Conclusion Minimally invasive puncture at two targets is a simple, safe, effective and mini-invasive treatment for thalamic hemorrhage with entering into the ventricle and accompanied by hydrocephalus.