CT导引下立体定向脑血肿抽吸术

目的评价CT导引下立体定向脑血肿抽吸术的临床应用价值。方法选择1989年10月～2001年11月入院治疗的脑血肿患者1020例,应用CJF型和Fischer2D型立体定向仪于CT导引下施行脑血肿抽吸治疗。根据CT扫描图像直接测算出脑血肿靶点的X,Y,Z轴坐标,标出靶点位置、抽吸针的行径和进针深度,确保抽吸针到达预定的靶点。1020例患者中基底节区血肿618例、丘脑血肿160例、脑叶血肿182例、小脑血肿6例、脑干血肿40例和脑室出血14例。结果686例患者血肿抽吸量>80%,248例为50%～80%,72例<50%,14例因血肿未液化难以抽出积血。手术后再次出血是主要并发症,发生率为1.17%。1020例中存活835例(81.9%),死亡185例(18.1%)。手术后1个月和3个月进行随访,评估患者预后。根据日常生活能力(activitiesofdailyliving,ADL)评价标准,在随访的819例中1～2级者450例(54.9%),3级者196例(23.9%),4级者131例(16.0%),5级者42例(5.1%)。结论CT导引下立体定向脑血肿抽吸术是一种创伤小、安全、精确和简便的治疗方法。

CT guided stereotactic aspiration of intracerebral hematomas

Objective To evaluate the clinical application effect of CT guided stereotactic aspiration of intracranial hematomas.Methods A total of1020casese with intracerebral hematoma during October1989and November2001were performed CT guided aspiration with CJF and Fischer2D stereotactic systems.The X,Y,Z coordinates of the targets were directly calculated and the needle path,puncture depth were de-termined according to CT scanning,so as to confirm accurate access and reach the destiny focus.Of those cases,618hematomas in basal ganglion,160in thalamus,182in cerebral lobe,6in cerebella,40in brain-stem and14in ventricle.Results More than80%volume of hematoma was evacuated in686cases,50%-80%in248and less than50%in72.It was difficult to evacuate the hematoma in14cases for not liquifying of hematoma.The important complication of CT guided stereotactic aspiration for intracerebral hematoma was rebleeding after operation and the morbidity was1.17%.Of these patients,835(81.9%)survived and185(18.1%)died.The survivors were followed up at one and3months post operation and their outcomes were e-valuated by activities of daily life(ADL)grade;54.9%(450/819)were in grade1-2,23.9%(196/819)were grade3,16.0%(131/819)were grade4and5.1%(42/819)were grade5.Conclusion The CT guided stereotactic aspiration for intracerebral hematoma is a minimally invasive,convenient and safe treatment with high accuracy and curative effect.