后颅窝小骨窗血肿清除引流联合脑室外引流治疗全脑室铸型出血

Ventriculopuncture combined with trans-posterior fossa craniotomy in treatment of intraventricular hemorrhage

目的探讨后颅窝小骨窗开颅血肿清除引流联合双侧脑室外引流治疗全脑室铸型出血的疗效。方法回顾分析我院神经外科高血压全脑室铸型出血80例临床资料,按照随机数字表法分为:实验组(40例)及对照组(40例)。实验组实施后颅窝小骨窗血肿清除引流联合双侧脑室外引流+尿激酶纤溶治疗,对照组实施传统的双侧脑室外引流+尿激酶纤溶治疗,分析比较两组患者的预后。结果实验组患者四脑室、三脑室、侧脑室内血肿术后大部分清除,血肿清除时间实验组平均为(5±2)d,对照组平均为(9±3)d,差异具有统计学意义(P<0.01)。实验组病死率为5%,对照组为22.5%,差异有统计学意义(P<0.01)。术后随访6个月,两组存活患者日常生活能力量表(ADL)对比差异具有统计学意义(P<0.05)。结论后颅窝小骨窗血肿清除引流联合双侧脑室外引流治疗全脑室铸形出血降低了病死率、改善了预后,是一种安全、有效的治疗方法。

Objective To evaluate the clinical value of ventriculopuncture combined with the trans-posterior fossa craniotomy in treatment of intraventricular hemorrhage.Methods In retrospective analysis of clinical data of neurosurgery department from Octo-ber 2010 to October 2014,there were 80 hypertensive intraventricular hemorrhage patients in the study group （40 cases） and control group （40 cases） .The study group patients were treated with ventriculopuncture combined with trans-posterior fossa craniotomy and u-rokinase fibrinolytic therapy;the control group patients were treated with ventriculopuncture and urokinase fibrinolytic therapy.And a-nalysis of their prognosis was made.Results The hematoma in the lateral ventricle,the third ventricle and the fourth ventricle were re-moved postoperatively,the removal time of hematoma in study group was （ 5 ±2 ） days, compared with （ 9 ±3 ） days in the control group, with statistically significant difference （P〈0.01）;and the mortality was 5%in the study group,compared with 22.5%in the control group, the difference was significant （P〈0.01）.The activities daily living score （ADL） in surviving patients improved in the following 6 months（P〈0.05）.Conclusions Ventriculopuncture combined with trans-posterior fossa craniotomy in treatment of intra-ventricular hemorrhage is effective, which significantly reduces the mortality rate and improves the prognosis of patients.