摘要
目的探讨慢性扩张性脑内血肿（CEICH）的诊断依据和处理原则。方法对1987年6月至2012年1月山东省潍坊市人民医院、山东大学第二医院等4家医院神经外科收治的42例CEICH的资料42例CEICH患者的发病过程、临床表现、影像学特点、术中所见、病理结果、术后随访等方面结合文献进行回顾性研究。结果本组患者病程22d至10年，均为慢性起病，其中23例误诊（54．8％），分别误诊为囊性胶质瘤、脑囊虫病、脑脓肿、肿瘤卒中等。自1997年6月年以来误诊率下降为19．0％。38例患者进行了开颅手术治疗，4例行血肿穿刺引流术。无手术死亡病例，33例恢复良好，9例有不同程度的神经功能障碍。随访1～21年，1例患者于术后10年复发，1例多发性CEICH，未手术处理的2个小病变1个7年后有所增大，另外1个自行消失。结论诊断CEICH的依据：（1）影像学提示脑实质内的囊性占位性病变；（2）病灶周围有圆形或类圆形不规则强化；（3）MRIT1WI呈混杂信号的同心圆板层状结构（“年轮征”）；（4）CTA、MRA、DSA显示病灶区异常血管影；（5）缓慢进展的颅内高压症状和临床体征。有占位效应和临床症状的血肿应予手术清除血肿和异常组织，并切除包膜，小血肿（〈2cm）可随访观察。
Objective To summarize our own experiences of managing chronic expanding intracerebral hematoma （CEICH） and discuss its diagnosis and treatment. Methods The courses of CEICH, clinical and imaging features, intraoperative findings, pathological examinations and follow-up outcomes were reviewed retrospectively. The relevant literatures were reviewed simultaneously. Results The course of CEICHs ranged from 22 days to 10 years. Twenty-three cases （54. 8% ） were misdiagnosed as cystic gliomas, cystic gliomas, brain cysticercoses, brain abscesses and tumor strokes, etc. The misdiagnostic rate had decreased to 19.0% since June 1997. Thirty-eight patients underwent surgical operations and 4 had puncture drainage of hematoma. There was no operative death. Thirty-three cases achieved an excellent recovery and 9 cases had varying degrees of nervous dysfunctions. The follow-up period was 1 -21 years. One patient had recurrence after 10 years. Among the cases of muhiple CEICH, two lesions underwent no surgical treatment. One increased obviously after 7 years and another disappeared. Conclusion The following five points may be used as the diagnostic criteria of CEICH ： （ 1 ） intracerebral cystic space-occupying lesions on brain images; （2） circular or circle-like enhancement around lesions; （3） a mixed signal of concentric circular lamellar structures on MRI T1WI; （4） abnormal vascular lesions on CTA, MRA or DSA ; （5） clinical signs and symptoms of slow progress of iutracranial pressure. CEICHs with clinical symptoms of local mass effect shall be obliterated surgically. The abnormal tissues in cyst wall of hematoma should be resected. Small hematomas （ 〈 2 cm） may be followed up.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2012年第29期2059-2062,共4页
National Medical Journal of China
关键词
脑疾病
血肿
诊断
治疗
Brain diseases
Hematoma
Diagnosis
Therapeutics
