破裂动脉瘤术中脑室穿刺留置外引流的技术探讨

Technical exploration of intraoperative ventricular puncture and external drainage during clipping surgery of ruptured aneurysms

目的总结破裂动脉瘤病人术中脑室穿刺置管外引流技术的具体操作方法 ,对穿刺点的选择及穿刺置管的技术要点进行技术总结及探讨。方法回顾性分析采用开颅夹闭的60例破裂动脉瘤病人的临床资料,术中行脑室穿刺外引流术,采用paine点穿刺20例,改良paine点穿刺20例,脑沟回定位法20例。结果除1例脑室狭小病人穿刺失败外,59例病人术中脑组织塌陷良好,其中1例术后复查出现脑室内出血,经引流后恢复良好。结论 paine点穿刺、改良paine点穿刺、脑沟回定位法均能准确穿刺到侧脑室,为动脉瘤夹闭提供操作空间,改良paine点穿刺法最为简单实用。

Objectives To summarize the specific methods of intraoperative ventricular puncture and external drainage in ruptured aneurysms patients with subarachnoid hemorrhage and summarize and explore the choice of puncture site and the technical key points for puncturing and catheter placement.Methods Clinical data of 60 patients undergoing intraoperative ventricular puncture and external drainage during intracranial aneurysm clipping surgery were analyzed retrospectively.The puncture via traditional paine point was performed in 20 patients,via improved paine point in 20 and via point located according to cerebral gyrus in 20.Results The puncture failed because of small ventricle in one patient.Intraoperative brain tissue collapse was good in 59 patients.Intraventricular hemorrhage occurred in 1 patient who recovered well by ventricle drainage.Conclusions The puncture into the lateral ventricle can be finished accurately by three methods,which can provide operating space for aneurysm clipping.The improved paine point puncture is the most simple and practical method.