摘要
本文报告高血压脑出血30例采用CT立体定向术行血肿排空.平均年龄57岁,出血量最多是96ml,平均43ml,血肿破入侧脑室及第三、四脑室有铸型者21例.术前大部分合并有多脏器功能障碍,常规开颅清除血肿往往使这类病人难以耐受手术再次打击.作者通过临床手术治疗分析.体会到CT立体定向手术具有微创性,定位精确,手术时间短,副损伤轻.对存在多脏器功能障碍的病人全身干扰小.术后恢复快.对多层面的血肿靶点宜选在血肿中心层为佳,有利于血肿排空.对血肿破入脑室者,双侧选择靶点置管尿激酶溶液冲洗引流.同时腰穿放出血性脑脊液是尽快解除脑室梗阻的一种有效方法.注重多脏器功能衰竭的预防和治疗是提高CT立体定向术成功的关键.
Thirty cases of hypertensive intra-cerebral hemorrhage were evacuated with CT guided stereotactic operation. The average age of patients was 57 years old. The average volume of hematomas was 43ml, the maximum one was 96ml. 21 cases of hematomas had already ruptured into lateral ventricle with casting mould. Some patients were suffering from multiple organs disfunction before operation. so these patients could not tolerate the routine craniotomy. The advantage of CT guided stereotactic operation was minimal operative injury, accurate orientation, mild side effect and rapid recovery. The target of the center of hematomas should be selected for the multi-layered hematomas in order to evacuate the blood clot as much as possible. If the hematomas ruptured into the lateral ventricle , bilateral targets sJiould be selected in order to insert a tube for urokinase irrigation. At the same time the lumber puncture should be performed for drainage of the bloody CSF to relieve the ventricular obstruction. The authors emphasized that to prevent and treat the multiple organs disfunction would be the most important problem.
