摘要
目的 探讨便携式头颅CT导航下锁孔微创手术治疗幕上高血压脑出血的疗效及安全性. 方法 在北京军区总医院附属八一脑科医院自2010年1月至2012年12月连续收治的高血压脑出血致昏迷患者中,选择出血量有手术指征（出血量24～90 mL）的35例患者行便携式头颅CT导航下锁孔微创手术.采用格拉斯哥昏迷评分（GCS）和改良的Rankin评分（mRS）评估患者术前术后的神经系统状态.随访6个月后采用格拉斯哥预后评分（GOS）评价患者的转归. 结果 35例患者急诊入院到手术的平均时间为（11.22±6.37）h,CT扫描平均时间为（19.00±13.11） min,手术平均时间为（108.49±26.61） min.血肿全部或近全部清除（清除率＞90％）者32例（91.43％）,血肿平均清除率为96.9％（77.9％～99.4％）.术后GCS评分[0～15分（中位数14分）]和mRS评分[0～6分（中位数3分）]均较术前[GCS评分为3～15分（中位数9分）；mRS评分为2～5分（中位数4分）]有明显的改善.随访6个月后57.1％（20/35）的患者预后良好（GOS评分4～5分）,2例患者死亡. 结论 便携式头颅CT导航下锁孔微创血肿清除术不仅可减少手术损伤,而且可提高手术效率及血肿清除率,从而有效改善患者的预后.便携式头颅CT能快速给予术前导航,对高血压脑出血患者的手术治疗可提供很大的帮助.
Objective To evaluate the outcome and safety of portable 3D head computed tomography （CT） navigation-guided keyhole microsurgery in patients with hypertensive intracranial hematomas （HICH）.Methods Thirty-five consecutive unconscious patients with a volume of HICH at 24-90 mL,admitted to our hospital from January 2010 to December 2012,were treated with 3D image-guided keyhole microsurgery.The preoperative and postoperative neurological status determined by Glasgow Coma Scale （GCS） and modified Rankin Scale （mRS）.Outcome at six months was assessed by Glasgow Outcome Scale （GOS）.Results Average time from admission to the operation room,time for CT scan,and average operation time were （11.22±6.37） h and （19±13.11） min and （108.49±26.61）min,respectively.The total and near total （〉90%） hematoma evacuation rate was 96.9%.The mRS and GCS scores were significantly improved at discharge as compared with those before surgery （F=6.487,P〈0.05）.Six months after the surgery,57.1% patients achieved good recovery （GOS scores 4-5）,and two patients died.Conclusion Keyhole minimally invasive hematoma with the help of portable head 3D reconstructed CT scan is highly effective in obtaining immediate and complete hematoma evacuation;portable CT is reliably and effective for preoperative navigation,and is very helpful for surgical management of patients with HICH.
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2013年第8期806-809,共4页
Chinese Journal of Neuromedicine
关键词
便携式头颅CT
高血压脑出血
显微外科手术
Portable computed tomography
Hypertensive intracranial hematomas
Minimal invasive surgery
