适形微创吸引术治疗特大量高血压性脑出血

Aspiration of hypertensive intracerebral hematoma by minimal-trauma and shape means

目的 观察一种简便、易行、效果好的适形微创吸引术治疗特大量高血压性脑出血的新方法。方法 根据患者术前 CT片上的血肿形状采用简易立体定向多靶点径路微创颅内血肿清除术和术后残余血肿尿激酶溶解引流及对血肿破入脑室者配合腰穿脑脊液净化治疗特大量高血压性脑出血 31例。并与同期单径路微创颅内血肿清除术治疗特大量高血压性脑出血 2 9例进行比较。结果 血肿腔内置管准确率 1 0 0 %。术中血肿清除率和术后残余血肿清除时间均值 :多靶点径路为 5 4 .6 %和 3.5 d,单靶点径路为 32 .2 %和 5 .6 d,两方法比较有显著意义。治疗组术后血压下降及 2周后出现的并发症及愈后与对照组比较 ,差异有显著意义。结论 适形微创吸引术治疗特大量高血压性脑出血是一种定位准确 ,方法简易 ,创伤微小 ,清除血肿率较高 ,疗效确切 ,易于推广普及的新技术。

Objective To study a new method of aspiration of hypertensive intracerebral hematoma by minimal trauma and shape means which proved to be simple,practical and effective.Methods According to hematoma shape on CT film before operation,31 patients with particular large volume of hypertensive intracerebral hematoma were adopted aspiration by minimal trauma and shape means with simply serotaxic and more target approaches and the tube was left as drainage for further administration of urkinase and aspiration of the residual dissolved hematoma.Lumbar punctures for purificatio of cerebrospinal fluid were also performed in patients with intraventricular hematomas.The effect was compared with that in 29 patients with hypertensive cerebral bleeding treated wth single target approach.Results The accuracy of installing tubes into the cavity of hematoma was 100%.The rate of hematoma evacuation during operations and the mean drainaging time were 54.6% and 3.5 d respectively in patients with more target approaches,which were markedly different from those in control group(32.2% and 5.6 d with single target approach).Conclusion The aspiration of hypertensive intracerebral hematoma by minimal trauma and shape means is a new technique,which has been proved to be accurate,effective and simple.The trauma is minimal and the rate of hematoma evacuation is high with this technigue.