三维重建单(双)靶点定向置管引流术治疗高血压壳核出血

Three dimension rebuilding guidance stereotactic single/double track aspiration and thrombolysis for hypertensive putaminal hemorrhage

目的回顾性分析三维重建单(双)靶点定向置管引流术治疗高血压壳核出血的疗效,验证该方法的有效性和可行性.方法将133例壳核脑出血病人的CT定位扫描资料输入计算机工作站,对血肿进行三维重建,根据血肿量的大小和形状设计1～2个靶点和引流管路径.应用立体定向技术将引流管(外径5mm,内径3mm)送至颅内预定靶点,术中应用10ml注射器轻柔抽吸血肿液化部分,术后将尿激酶(1～2万IU)注入血肿腔内,夹闭引流管2 h后自然引流,每12 h重复1次.复查CT证实剩余血肿量为最初的10%～15%时拔除引流管.结果平均置管1.5 d(1～3 d),平均血肿排空率92.8%.术后1个月病死率6.0%,远期随访(平均22个月)病死率11.3%,优良率74.4%.结论该方法治疗高血压壳核脑出血,血肿排空较彻底,疗效可靠,尤其适用于血肿量较大(＞25ml)且形态不规则的颅内血肿.

Objective To assess the feasibility and efficacy of 3-D rebuilding guidance stereotactic single/double track aspiration and fibrinolysis for hypertensive putaminal hemorrhage. Methods 133 cases were reviewed. Data gathered from CT was transferred into the computer workstation, where the three dimensions of the intracerebral hematoma was rebuilt. According to the shape and the volume of hematoma, 1 or 2 targets and the track of the catheters were designed. Catheters (5mm outer diameter, 3mm inner diameter) were stereotactically put into those targets according to plan. 10 000-20 000 IU urokinase was infused into the cavity of hematoma after aspiration, the tubes were clamped for 2 hours and then opened to drain with normal pressure, and was repeated every 12 hours until CT showed the hemorrhage reached 10%- 15% of initial volume. Results After drainage of 1-3 days (mean 1.5 days), initial hemorrhage volume was reduced an average of 92.8%. 8 patients (6.0%) died at one month follow-up, 15 patients (11.3%) died at mean 22 months (5-46 months) follow-up, 99 patients (74.4%) got favorable outcome. Conclusion Stereotactic single/double track aspiration and fibrinolysis with 3-D guidance, was demonstrated to be effective and safe in reducing hemorrhage volume and improve outcome for putaminal hematoma, especially for those who with large (>25ml) and irregular hematoma.