微创颅内血肿清除术的临床应用

The clinical application of microsugical treatment on intracranial hematoma

目的 总结该院 4 3例微创颅内血肿清除术疗效。方法 外伤性颅内血肿急诊穿刺治疗 ,高血压脑出血均于发病后 6h后完成穿刺治疗 ,应用YL - 1型一次性使用颅内血肿穿刺针 ,依据CT摄片 (基线 ) (层距等 )确定血肿中心的颅表定位 ,选择合适长度的穿刺针 ,针钻一体送入血肿中 ,退下针芯 ,内经 3mm不锈钢穿刺针稳定固定在颅骨上 ,侧孔接引流管 ,抽出血肿 ,若为液态缓慢吸出 ,若为血凝块则抽出或应用粉碎针粉碎部分血肿后血肿腔内注入液化剂 ,保留 4h后开放引流 ,术后 1,3,5d复查CT。结果 术后 (经CT检查证实 )血肿清除量大于 90 % 11例 ,80 %～ 90 % 2 0例 ,小于 5 0 % 4例。存活 4 1例 ,死亡 2例。存活 4 1例 ,半年后随访 ,ADL1(社会生活能力正常 ) 32例 ,ADL2 (有自理生活能力 ) 4例 ,ADL3(部分生活自理 ) ) 2例 ,ADL4 (卧床 ) 2例 ,ADL5 (植物生存 ) 1例。结论 该方法适用于各种年龄及颅内出血的病人 ,特别适用于高龄、危重患者 ,穿刺的时机越早越好。

Objective: To summarize the effect of microsurgical treatment on 43 intracranial hematoma. Methods: Treat intracranial hematoma on traumatic emengency , treat after 6hours on hypertensive cerebral hemorrhage, we operate with the intracranial hematoma puncture needle(YL-1).Locate the puncture point and choose proper length of the needle by CT scan (baseline, layers etc.). Puncture the needle into the hematoma along with the drill. Extract the needle core, then the 3 mm diameter puncture needle is fixed on skull, conjunct drainage tube to side aperture, abstract the hematoma, if it's liquid abstract it slowly, if it's clot abstract it or smash it with smashing needle, then inject liquefier, keep the liquefier in hematoma for 4hours,drain it. Double-check separately after the surgery 1,3,5 days.Results:After the treatment,(proved by CT scan),the clearance rate of hematoma beyond 90 per 1 lcases,80～90 per 20 cases, under 50 per 4cases. Alive 41 cases,death 2 cases. In the 41 alive cases, follow-up survey after halfa year showed: ADLI 32 cases, ADL 24 cases, ADL3 2 cases,ADL4 2 cases,ADL5 1 cases.Conclusions:This method are fit to intracranial hematoma patients of any age, specially fit to old-aged or serious patients, the time of surgery earlier the effect better.