摘要
目的探讨神经内镜清除高血压基底节区脑出血的疗效及手术技术要点。方法回顾分析南京大学医学院附属鼓楼医院神经外科自2016年6月—2018年12月收治的31例高血压基底节区脑出血患者的临床资料;患者均在神经内镜下由皮层穿刺行血肿清除。总结分析患者的疗效,以及神经内镜下止血、提高血肿清除率、防止再出血的手术技术要点。结果本组患者均有高血压病史,脑出血均经头颅CT检查确诊;术前平均血肿体积为(48.81±9.13)cm^3,术中出血量(120.12±21.27)mL,手术时间(83.11±12.56)min。术后24 h内复查头颅CT示平均血肿清除率为90.33%。术后,1例患者并发肺部感染死亡,1例患者发生深静脉血栓死亡。术后平均随访患者6个月以上,其中日常生活活动能力(activity of daily living,ADL)评分为Ⅰ级者17例、Ⅱ级4例、Ⅲ级5例、Ⅳ级3例。结论神经内镜在高血压基底节区脑出血清除术中具有创伤小、对脑组织激惹较小及术后恢复快的优点,可提高手术效率并减少副损伤。
Objective To discuss the key points of neuroendoscopy in the removal of hypertensive basal ganglia cerebral hemorrhage and discuss its therapeutic effect and surgical experience.Methods The clinical data of 31 patients with hypertensive basal ganglia cerebral hemorrhage admitted by department of Neurosurgery,NanJing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School from June 2016 to December 2018,were analyzed retrospectively.The hematomas were removed by cortical puncture under neuroendoscopy.The surgical efficacy and postoperative complications were analyzed,and the main points of surgical techniques such as hemostasis,improvement of hematoma clearance rate and prevention of rebleeding were summarized under neuroendoscopy.Results All the patients in this group had a history of hypertension and received preoperative diagnosis of cerebral hemorrhage by CT scan.The mean preoperative hematoma volume was(48.81±9.13)cm^3,intraoperative blood loss was(120.12±21.27)cm^3,and the operative time was(83.11±12.56)min.The average hematoma clearance rate was 90.33%within 24 hours after the operation.In this group,1 patient died of pulmonary infection after operation,1 patient died of deep vein thrombosis.The patients were followed up for an average of more than 6 months,including 17 patients with ADL grade Ⅰ,4 patients with ADL grade Ⅱ,5 patients with ADL grade Ⅲ,and 3 patients with ADL grade Ⅳ.Conclusions The advantages of neuroendoscopy in hypertensive basal ganglia cerebral hemorrhage include less trauma,less irritation to brain tissue and faster postoperative recovery.The efficiency of operation can be improved by reasonable preoperative evaluation and accurate intraoperative positioning.Neuroendoscopy can create better conditions for improving postoperative quality of life in patients of basal ganglia cerebral hemorrhage.
作者
陆天宇
刘浩
陈维涛
梁维邦
倪红斌
金伟
LU Tian-yu;LIU Hao;CHEN Wei-tao(Department of Neurosurgery,NanJing Drum Tower Hospital,Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)
出处
《临床神经外科杂志》
CAS
2019年第6期487-491,共5页
Journal of Clinical Neurosurgery
基金
南京市科技局基金资助项目(201803023)
关键词
神经内镜
基底节区脑出血
高血压
neuroendoscopy
basal ganglia cerebral hemorrhage
hypertension
