双靶点单通道和多轴向立体定向脑内血肿排空术治疗自发性幕上脑出血患者近期疗效观察

Evacuation of spontaneous supratentorial intracerebral hematoma with double targets-single channel and multiaxial stereotaxis

目的：评估双靶点单通道和多轴向立体定向脑内血肿排空技术在自发性幕上脑出血患者外科治疗中的有效性和安全性。方法：收集2014年1-11月在浙江大学医学院附属第二医院神经外科住院并接受双靶点单通道和多轴向立体定向脑内血肿排空术治疗的34例自发性幕上脑出血患者（双靶点组）的临床资料，并与2013年1月至2014年11月在同科住院并接受传统单靶点单通道方法行立体定向脑内血肿排空术的27例自发性幕上脑出血患者（单靶点组）进行比较，评估其手术疗效和安全性。结果：双靶点组术前血肿量11．7～89．5mL，平均（38．6±19．2）mL，格拉斯哥昏迷评分（GCS）3～15分，平均（9．6±3．2）分；单靶点组术前血肿量17．7～83．4mL，平均（40．1±18．1）mL，GCS3～13分，平均（9．1±2．9）分，两者差异均无统计学意义（均P〉0．05）。双靶点组术后24h残余血肿量1．8～20．1mL，平均（11．1±4．2）mL，清除率（73．1±5．4）％；单靶点组术后24h残余血肿量4．2～30．9mL，平均（18．5±5．3）mL，清除率（55．1±5．1）％，两者差异均有统计学意义（均P〈0．05）。出院后1个月随访格拉斯哥预后评分，两组间差异无统计学意义（P〉0．05）。双靶点组术后住院天数为3～50d，平均住院日12．6d，单靶点组术后住院天数2～49d，平均住院日14．2d。结论：双靶点单通道和多轴向立体定向血肿排空技术应用于自发性幕上脑出血患者可提高血肿清除率，促进患者术后恢复，降低平均住院日。

Objective： To evaluate the efficacy and safety of evacuation of spontaneous supratentorial hemorrhage with double targets-single channel and multiaxial stereotaxis. Methods： Thirty-four patients with supratentorial intracerebral hemorrhage, who underwent hematoma evacuation with the method of double targets-single channel between January 2014 and November 2014 in the Second Affiliated Hospital, Zhejiang University School of Medicine, were included in the study. We classified the hematoma into four types based on the principle of double targets-single channel calculation method （DTSC）. And the appropriate stereotactie surgery path and operation opportunity were designed individually according to the hematoma volume and mass effect. Twenty-seven patients with supratentorial hemorrhage who underwent hematoma evacuation with the method of single targets-single channel between January 2013 and November 2014 were selected as single target group. Results： Volumes of initial hematoma in DTSC and single target groups were （38.6± 19.2 ） mL and （40. 1 ± 18.1 ）mL, respectively. Initial Glasgow Coma Scale were 9.6 ± 3.2 （3 - 15） and 9.1±2.9（3 - 13） （all P 〉0.05）. Residual volume of hematoma and clearance ratio were （11.1±4.2） mL and（73.1±5.4）% in DTSC group and （18.5 ±5.3） mL and（55. 1±5.1 ）% in single target group by CT scan 24 h after operation（ all P 〈 0.05 ）. There was no significant difference in Glasgow Outcome Scale between two groups in one-month follow-up. Average length of postoperative stay of two groups were（ 12. 6 ± 9.8 ） d and （ 14. 2 ± 7. 1 ） d, respectively. Conclusion： Evacuation of spontaneous supratentorial intracerebral hematoma with DTSC and multi-axial stereotaxis can increase clearance ratio remarkably and decrease average length of stay.