您的位置：山东大学 -> 科技期刊社 -> 《山东大学学报（医学版）》

山东大学学报（医学版） ›› 2017, Vol. 55 ›› Issue (5): 61-65.doi: 10.6040/j.issn.1671-7554.0.2016.1439

• 临床医学 • 上一篇    下一篇

CT定位微创徒手穿刺软通道技术治疗中等量高血压脑出血68例

王维军,周宁全,王超   

  1. 贵州省黔南州人民医院神经外科, 贵州 都匀 558000
  • 收稿日期:2016-11-04 出版日期:2017-05-10 发布日期:2017-05-10
  • 通讯作者: 王维军. E-mail:751829615@qq.com E-mail:751829615@qq.com

Treatment of 68 cases of moderate volume of hypertensive intracerebral hemorrhage with free hand technique of minimally invasive puncture of the soft channel under CT orientation

WANG Weijun, ZHOU Ningquan, WANG Chao   

  1. Department of Neurosurgery, The Peoples Hospital of QianNan, Duyun 558000, Guizhou, China
  • Received:2016-11-04 Online:2017-05-10 Published:2017-05-10

PDF (PC)

112

摘要： 目的 探讨CT定位微创徒手穿刺软通道技术治疗中等量高血压脑出血的治疗效果。 方法 回顾分析158例20~40 mL高血压脑出血患者的治疗效果,其中采用微创手术68例(微创手术组),非手术治疗90例(非手术组),术后随访1个月。对患者死亡率、血肿清除时间、神经功能缺损等临床资料进行分析总结。 结果 死亡率:微创手术组2.90%,非手术组16.88%,二者差异有统计学意义(P<0.05);血肿完全引流/吸收平均时间:微创手术组(5±2.1)d,非手术组(21±3.5)d,二者差异有统计学意义(P<0.05);NIHSS评分:治疗后1个月,微创组明显低于非手术组(P<0.01)。 结论 微创手术治疗中等量高血压脑出血疗效可靠,血肿清除时间短,死亡率较低。

关键词: 高血压脑出血, 微创手术, 徒手穿刺, 软通道技术, 电子计算机断层扫描(CT)

Abstract: Objective To explore the efficacy of mini-invasive surgical treatment of moderate volume of hypertensive intracerebral hemorrhage. Methods The clinical data of 158 cases of hypertensive intracerebral hemorrhage(20- 40 mL)treated during Nov. 2011 and June 2015 were retrospectively analyzed. Of all patients, 68 underwent minimally invasive surgery(mini-invasive group), and 90 received non-surgical treatment(non-surgical group). The patients were followed up for 1 month. The mortality, hematoma evacuation time, and score of National Institutes of Health Stroke Scale were compared between the 2 groups. Results The mortality was 2.90% in the mini-invasive group, and 16.88% in the non-surgical group, with significant difference between the 2 groups(P<0.05). The hematoma evacuation time was 5±2.1 days in the mini-invasive group, and 21±3.5 days in the non-surgical group, with significant difference between the 2 groups(P<0.05). One month after treatment, the NIHSS score in the mini-invasive group was significantly lower than that in the non-surgical group (P<0.01). Conclusion Mini-invasive surgical treatment of moderate volume of hypertensive intracerebral hemorrhage is reliable, with short hematoma evacuation time and low mortality.

Key words: Hypertensive intracerebral hemorrhage, Minimally invasive surgery, Computed Tomography, Free hand puncture, Soft channel technique

中图分类号: 

  • R743.34
[1] Balami JS, Buchan AM. Complications of intracerebral haemorrhage[J]. Lancet Neurol, 2012, 11(1): 101-118.
[2] Steiner T, Bosel J. Options to restrict hematoma expansion after spontaneous intracerebral hemorrhage[J]. Stroke, 2010, 41(2): 402-409.
[3] Feigin VL, Lawes CM, Bennett DA, et al. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: A systematic review[J]. Lancet Neurol, 2009, 8(4): 355-369.
[4] Mendelow AD, Gregson BA, Femandes HM, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage(STICH): a randomised trial[J]. Lancet, 2005, 365(9457): 387-397.
[5] 王维军, 周宁全, 杨华. 35例基底节区高血压脑出血术后再出血的多因素分析[J]. 贵州医药, 2013, 37(12): 1084-1086.
[6] Van Asch CJ, Luitse MJ, Rinkel GJ, et al. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: A systematic review and metaanalysis[J]. Lancet Neurol, 2010, 9(2): 167-176.
[7] 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国脑出血诊治指南(2014)[J]. 中华神经科杂志, 2015, 48(6): 435-444.
[8] Mendelow AD, Gregson BA, Rowan EN, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas(STICHⅡ): a randomised trial[J]. Lancet, 2013, 382(9890): 397-408.
[9] Vespa PM, Martin N, Zuccarello M, et al. Surgical trials in intracerebral hemorrhage[J]. Stroke, 2013, 44( 1): 79-82.
[10] 黄欣, 金晶, 黄红光. 去骨瓣减压术并发症分析[J]. 中华创伤杂志, 2011, 27(5): 403-405. HUANG Xin, JIN Jing, HUANG Hongguang. Complications secondary to decompressive craniectomy[J]. Chinese Journal of Trauma, 2011, 27(5): 403-405.
[11] 左光银, 于宏伟, 袁玉会, 等. 不同术式治疗高血压脑出血的疗效比较[J]. 中国医科大学学报, 2012, 41(6): 565-567. ZUO Guangyin, YU Hongwei, YUAN Yuhui, et al. Comparison of different operative methods for hypertensive intracerebral hemorrhage treatment[J]. Journal of China Medical University, 2012, 41(6): 565-567.
[12] 王维军, 杨华. 微创软通道治疗高血压脑出血85例的临床分析[J]. 中国医药科学, 2014, 4(20): 31-33. WANG Weijun, YANG Hua. Clinical analysis on 85 cases of hypertensive cerebral hemorrhage with minimally invasive soft channel technology[J]. China Medicine & Pharmacy, 2014, 4(20): 31-33.
[13] 何建青, 刘斌, 蔡学见, 等. 神经内镜辅助小骨窗开颅治疗老年高血压脑出血[J]. 中华神经外科杂志, 2012, 28(2): 199-202.
[14] 张金锋, 陈金寿, 陈建彬, 等. 微创理念对手术治疗高血压基底节脑出血预后的影响(附57例报道)[J].中华神经医学杂志, 2012, 11(4): 401-404.
[15] 王维军, 周宁全, 张文川, 等. 微创软通道技术治疗急性硬膜外血肿45例[J]. 中国微侵袭神经外科杂志, 2013, 18(2): 86.
[16] 孔文涛, 常小龙, 赵德清, 等. 微创手术治疗高血压脑出血[J]. 中华神经外科疾病研究杂志, 2011, 10(3): 276-277.
[17] Mould WA, Carhuapoma JR, Muschelli J, et al. Minimally invasive surgery plus recombinant tissue-type plasminogen activator for intracerebral hemorrhage evacuation decreases perihematomal edema[J]. Stroke, 2013, 44(3): 627-634.
[18] 吴修华, 杜杰. 微创颅内血肿清除术治疗高血压脑出血临床观察[J]. 山东大学学报(医学版), 2014, 52(s2): 84.
[19] 崔元孝, 唐茜茜, 郭章玉, 等. 微创血肿抽吸术后大鼠脑出血周围组织细胞凋亡的研究[J]. 山东大学学报(医学版), 2012, 5(5): 36-39. CUI Yuanxiao, TANG Qianqian, GUO Zhangyu, et al. Experimental research of apoptosis in rat tissue cells surrounding intracerebral hemorrhage after minimal hematoma aspiration[J]. Journal of Shandong University, 2012, 5(5): 36-39.
[20] Wang W. Minimally invasive surgical treatment of acute epidural hematoma: case series[J]. Biomed Res Int, 2016, 2016: 6507350. doi:10.1155/2016/6507350.
[1] 商笑1，崔元孝1，刘晓雨1，冯肖亚2. 人脐带间充质干细胞联合血肿抽吸术治疗大鼠脑出血的实验研究[J]. 山东大学学报(医学版), 2013, 51(10): 10-14.
[2] 崔元孝1，唐茜茜1，郭章玉1，商笑1，张清华1，冯肖亚2 . 微创血肿抽吸术后大鼠脑出血周围组织细胞凋亡的研究[J]. 山东大学学报(医学版), 2012, 50(5): 36-.
[3] 唐茜茜1，袁倩2，崔元孝1，张清华1，郭章玉1. 热休克蛋白70对脑出血大鼠神经细胞Bcl-2、Bax蛋白表达的影响[J]. 山东大学学报(医学版), 2011, 49(11): 40-.
[4] 田敏，袁倩，崔元孝，张清华，唐茜茜. 微创血肿清除术患者纤溶活性动态变化的研究[J]. 山东大学学报(医学版), 2010, 48(10): 73-76.
[5] 于兆昂，崔元孝，张清华，田敏，唐茜茜. 脑出血患者微创血肿清除术后血清IL-6及MMP-9的动态观察[J]. 山东大学学报(医学版), 2010, 48(2): 105-.
[6] 周庆博,李鲁扬,贾青,毕建忠,邵念方 . 清热解毒法对脑出血大鼠的神经保护作用[J]. 山东大学学报(医学版), 2007, 45(9): 947-950.
[7] 屈传强,麻琳,郭洪志,贺燕,王蕾,李春海 . 急性脑出血致脑源性多器官功能障碍综合征模型IL-1β的基因表达及与血清内毒素的相关性研究[J]. 山东大学学报(医学版), 2007, 45(4): 353-356.
[8] . 微创血肿清除术对脑出血患者血清胶质纤维酸性蛋白的影响[J]. 山东大学学报(医学版), 2009, 47(9): 122-124.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
版权所有 © 2018 《山东大学学报(医学版)》编辑部　
地址:山东大学科技期刊社（济南市历城区山大南路27号山东大学中心校区明德楼B座721室） 电话: 0531-88366918 E-mail: xbyxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发