微创穿刺引流术治疗急性硬膜外血肿86例

目的探讨微创穿刺引流术治疗硬膜外血肿的疗效。方法采用CT引导定位,血肿中心为靶点,YL-1型颅内血肿粉碎穿刺针经头皮穿刺冲洗粉碎引流联合尿激酶(2万~6万U)溶解血肿治疗硬膜外血肿86例。结果大血肿组(血肿量30~100 m l)44例,无效10例(22.7%,10/44),改行开颅血肿清除术后痊愈;余34例中术后3~5 d血肿引流干净25例,血肿少量残留(≤5 m l)9例。小血肿组(血肿量<30 m l)42例,术后1~3 d内均引流干净。出院时ADL分级:Ⅰ级72例,Ⅱ级14例。76例随访3~12个月,(5.3±3.7)月,按GOS分级均恢复良好。结论微创穿刺引流术治疗硬膜外血肿疗效确切、微创,准确选择适应证、把握手术时机至关重要。     

高血压性脑出血的微创穿刺治疗

目的探讨微创穿刺引流术治疗高血压性脑出血的疗效。方法根据CT定位确定穿刺点、穿刺方向及穿刺针长度,电钻将YL-1型一次性颅内血肿穿刺针送入血肿靶点,抽吸血肿后,血肿腔内分次注入尿激酶溶解引流出残存血肿,动态复查CT了解血肿清除情况并结合病人临床症状择期拔针。结果死亡33例,病死率18.3%(33/180)。随访64例,3~6个月后按日常生活能力(activity of dailylife,ADL)分级评定,ADL1级12例,ADL2级20例,ADL3级24例,ADL4级6例,ADL5级2例。结论微创穿刺引流术治疗高血压性脑出血简便、快捷、创伤小、疗效好。     

急性外伤性硬膜外血肿的微创穿刺治疗

目的探讨微创穿刺引流术治疗急性外伤性硬膜外血肿的疗效。方法2009年6月-2012年6月采用YL-1型一次性颅内血肿穿刺针行微创穿刺引流术治疗外伤性硬膜外血肿68例。根据CT定位确定穿刺点、穿刺方向及穿刺针长度,以电钻将YL-1型一次性颅内血肿穿刺针送人血肿靶点,抽吸血肿后,血肿腔内分次注入尿激酶（一般用生理盐水2—5ml溶人20000～50000U尿激酶）溶解引流出残存血肿,术后复查CT,血肿基本清除、中线结构移位恢复后拔针。结果68例均穿刺成功。经CT确诊2d完全清除32例,3d22例,5d10例;2例并发新鲜出血中转开颅手术;2例并发脑疝术前采用此方法急救后改骨瓣开颅手术治愈。头痛立即缓解18例,肢体麻木无力立即消失3例,其他病例临床症状3～5d逐渐好转。术后住院7～15d,平均12d。68例随访3—6个月：完全失语1例,智力轻度减退4例（合并脑挫裂伤）,无死亡病例。结论微创穿刺引流术治疗急性外伤性硬膜外血肿操作简便、快捷、创伤小、疗效好。     

穿刺引流治疗外伤性硬膜下积液30例

报道穿刺引流治疗外伤性硬膜下积液30例,术前CT定位,在局麻下使用YL-1型颅内血肿粉碎穿刺针进行穿刺引流.全组均治愈,无一例死亡.术后硬膜外血肿1例,气颅3例,均治愈,随访6个月～1年6个月,平均9个月,未复发.     

改进的多侧孔YL-1型穿刺针及冲洗治疗高血压性脑出血430例报告

目的探讨改进的多侧孔微创穿刺针及冲洗技术治疗高血压性脑出血的疗效。方法将YL-1型颅内血肿粉碎微创穿刺针,末端加以多孔改进后,高温高压消毒后一次性使用。根据CT片行血肿靶点定位,对430例血肿量在25～120 ml进行穿刺引流,等量盐水反复冲洗,术后第2天注入尿激酶,旋转穿刺针并反复冲洗进行穿刺引流。结果穿刺针在脑内留置时间1～4 d,无一例头皮及颅内感染。拔针前及拔针后再出血36例,再出血率8.3%(36/430)。死亡29例,病死率6.7%(29/430),其中4例死于再出血脑疝,11例死于肺炎、心力衰竭,6例死于糖尿病合并肾功能衰竭,8例死于上消化道应激性溃疡出血。按日常生活能力分级(ADL)Ⅰ级85例,Ⅱ级189例,Ⅲ级77组,Ⅳ级17例,总有效率85.5%(368/430)。结论改进的多侧孔微创穿刺针直径相对增大,不易堵塞,冲洗引流通畅,能较快速清除血肿,降低脑内感染机会。     

微创穿刺冲洗引流治疗慢性硬脑膜下血肿69例

目的观察探讨微创穿刺冲洗引流治疗慢性硬脑膜下血肿(CSDH)的疗效。方法本组69例CSDH均经头颅CT和MRI检查确诊,采用YL-1型一次性使用颅内血肿粉碎穿刺针进行血肿微创穿刺,冲洗引流,血肿量约60~200 ml,引流时间3~5 d。结果69例穿刺经一次性冲洗引流后治愈,无术后并发症。结论CSDH行微创穿刺冲洗引流,创伤小,效果好,简便廉验,可作为CSDH的有效治疗首选方法之一。掌握手术操作技术是取得良好疗效的关键。     

微创颅内血肿清除术30例临床分析

目的总结微创颅内血肿清除术的经验。方法采用YL-1型1次性颅内血肿粉碎针,根据颅脑CT定位,取血肿最大层面,进行缓慢抽吸、冲洗、液化、引流、清除血肿。结果与结论颅内血肿微创清除术操作简单,创伤小、治愈率高。     

硬膜外血肿穿颅清除术24例临床体会

目的总结穿颅清除术治疗急性外伤性硬膜外血肿的临床体会。方法回顾性分析24例急性外伤性硬膜外血肿实施选择性穿颅清除术的临床资料,采用弦距定位法确定穿刺点,选用颅内血肿粉碎穿刺针进行穿刺、抽吸、冲洗、粉碎、液化及引流。结果本组平均治疗时间3.4(2~5)d,无一例再出血或死亡,亦无中转开颅手术,CT复查示血肿清除率达85%~95%,随访3~6个月,本组GOS评分均为良好。结论选择性穿颅清除术治疗急性外伤性硬膜外血肿方法简易、有效、安全、经济,值得推广。     

多点对冲引流治疗外伤性颅内血肿

目的探讨多点对冲引流治疗外伤性颅内血肿的疗效. 方法 2003年2～9月我院应用YL-1型一次性颅内血肿粉碎穿刺针同时进行2～3针穿刺对冲引流治疗28例外伤性颅内血肿. 结果治愈25例,治愈率89.3%(25/28),改开颅手术3例,其中死亡2例. 结论多点对冲引流治疗外伤性颅内血肿微创、安全、有效.     

多针微创穿刺结合持续对冲引流治疗重症高血压脑出血52例

本文报道2010年10月~2014年3月采用YL-1型颅内穿刺针在CT标志物定位下治疗重症高血压脑出血52例,根据患者病情采用多针微创穿刺结合持续对冲引流。穿刺后48小时以内血肿清除60%24例,30%~60%16例,30%12例。3例再出血(1例死亡,1例经抢救后稳定,1例放弃治疗),4例拔针后因经济原因放弃治疗。49例术后7 d内拔针,其余2例第9、13天拔针,拔针前血肿清除80%(14例血肿清除95%)。46例存活出院,随访3~6个月,平均4个月,格拉斯哥预后评分(Glasgow Outcome Score,GOS)5分16例,4分21例,3分5例,2分2例,1分(死亡)2例。     

微创穿刺引流治疗颅内血肿85例

目的探讨微创引流清除血肿术治疗颅内血肿的方法和效果。方法 85例颅内血肿患者,外伤性颅内血肿39例,高血压脑出血46例。局麻下用电钻将直径3 mm的YL-I型颅内血肿粉碎穿刺针穿刺到血肿内,先抽出血肿液态部分约50%～60%,剩下血肿用尿激酶液化引流。结果高血压脑出血患者围术期死亡2例,外伤性颅内血肿39例均康复。出院时ADL分级Ⅰ级41例,Ⅱ级25例,Ⅲ级14例,Ⅳ～Ⅴ级3例。81例得到随访,时间11（3～19）个月,完全恢复日常生活和部分恢复日常生活者63例（77.8%）,家庭生活需要人帮助或扶拐行走者13例（16.0%）,卧床不起但意识清楚或植物生存状态3例（3.7%）,死亡2例（2.5%）。结论微创引流治疗颅内血肿具有简便快捷、损伤轻微、耐受性好、康复快等优点,是治疗颅内血肿的一种较好方法。     

A comparative study on therapeutic method of traumatic epidural hematoma

Objective： To explore the therapeutic methods, surgical indications and clinical practice of minimally invasive surgery on traumatic epidural hematoma （EDH）. Methods： Retrospective study was made on 135 patients with traumatic EDH admitted into our hospital from June 2002 to August 2005. Sixty-five patients were treated with mini-invasive negative pressure drainage （treatment group）, 70 patients with comparable condition used traditional craniotomy （control group ）. The mean time of operation, average days in hospital, expenditure and prognosis of two groups were recorded and analyzed. Results： There was no significant difference in therapeutic efficacy between two groups. Patients in treatment group had a shorter hospital stay and less expenditure than those in control group. Conclusion： Mini-invasive negative pressure drainage is simple, effective, economical and applicable to some traumatic EDH patients.     

穿刺引流术治疗脑室出血115例报告

目的探讨微创穿刺引流术治疗脑室出血的疗效。方法 2005年11月-2010年11月对115例CT确诊脑室出血,其中重型脑室出血25例,根据患者脑室出血部位和体积选择性穿刺侧脑室额角,采用双侧或单侧脑室引流,术后尿激酶灌注冲洗,直至脑脊液正常,头颅CT确认血肿消失。结果住院期间治愈或好转88例（76.5%）,植物状态11例,死亡16例。98例随访3-12个月,平均6个月：78例复查头颅CT示脑室大小正常,再出血8例,继发性脑积水5例,死亡7例。结论脑室穿刺引流联合尿激酶灌注冲洗,能尽快清除脑室系统及蛛网膜下腔积血,对降低病死率,提高患者术后生存质量有重要意义。     

A case of infant epidural hematoma treated by continuous drainage of cephalohematoma

A female infant was born at 36 weeks with vacuum extraction. Her weight was 2.216 g and Apgar score was 9. She had a cephalohematoma at right parietal region. The cephalohematoma grew during 6 days after birth, then she came to our hospital. On arrival, her consciousness was alert and there were no neurological deficits. Her head circumference was 22.5 cm, and she had a pulsatile soft cephalohematoma, 7 cm in diameter, at right parietal region. Ultrasound examination showed a midline shift of the brain and CT scan revealed an epidural hematoma with bone fracture and cephalohematoma. We chose the puncture and continuous drainage of cephalohematoma as a primary therapy, because cephalohematoma was considered to be liquified and to be continuous to the epidural hematoma. The reason was that the pulsatile cephalohematoma became harder when she cried. The epidural hematoma was completely reduced on the next day's CT and then drainage was removed. She discharged on 15th post-operative day. We conclude that the puncture and continuous drainage of cephalohematoma may be one of the good therapeutic methods for the mild symptomatic neonate who has epidural hematoma with the cephalohematoma and bone fracture.     

Acute subdural haematoma after accidental dural puncture during epidural anaesthesia

A case is reported of acute intracranial subdural haematoma following accidental dural puncture during epidural anaesthesia. A 36-year-old primigravida with a gestation of 37 weeks and 3 days underwent caesarean section for which epidural anaesthesia was initially planned. An 18-gauge Tuohy needle was inserted into the L3-4 interspace but accidental dural puncture occurred. The needle was removed and general anaesthesia was initiated for surgery. On the second day post partum, the patient described a headache in both occipital area and neck that was relieved by lying down. On the seventh post-partum day she suffered tonic-clonic convulsions and underwent computerised tomography (CT). Despite different analgesic treatments and a normal CT, the patient suffered severe headaches in the following days. Magnetic resonance imaging revealed a 4-mm subdural hematoma in the right frontal area. The persisting headache decreased on day 12 and disappeared on day 14. The patient was discharged from hospital on day 15. The presence of post dural puncture headache complicated by atypical neurological deterioration following epidural anaesthesia should prompt the anaesthetist to consider the existence of intracranial complications and to seek immediate clinical and radiological diagnosis.     

微创穿刺术在外伤性脑出血中的应用

目的探讨微创穿刺术治疗外伤性脑出血的疗效。方法外伤性脑出血患者72例,随机分为微创组和开颅组,微创组接受微创穿刺术,开颅组采用骨瓣开颅血肿清除术。结果微创组平均住院时间明显少于开颅组,呼吸道感染、消化道出血以及电解质紊乱发生率明显低于开颅组（P〈0．05）;微创组昏迷患者平均清醒时间明显少于开颅组（P〈0．05）。微创组总有效率为88．9％,开颅组为75．0％。结论微创清除术治疗外伤性脑出血具有创伤小,操作简单,适应证广等诸多优点,临床医师应严格掌握手术操作要点并积极推广应用。     

高血压脑出血的微侵袭治疗

目的探讨高血压脑出血的术式选择策略及功能保护技巧。方法回顾性分析75例高血压脑出血手术治疗病例,其中传统骨瓣开颅31例;直切口小骨窗开颅19例;立体定向血肿穿刺引流25例。结果血肿完全清除18例,近全清除57例,术后1个月以内死亡5例（6.7%）。71例随访6～30个月,按ADL分级Ⅰ级15例（21.1%）,Ⅱ级20例（28.2%）,Ⅲ级21例（29.6%）,Ⅳ级10例（14.1%）,Ⅴ级5例（7.0%）。结论应根据术前病情分级、血肿CT分型、患者年龄等因素合理选择不同的手术方式。显微镜下微侵袭操作,三种手术方法均创伤小,术后神经功能恢复好且快。     

Single burr hole surgery for acute spontaneous subdural hematoma in the aged: patient reports of three cases

The method of treatment for acute spontaneous subdural hematoma in aged patients is controversial. Three cases of acute spontaneous subdural hematoma in aged patients, treated by single burr hole drainage without irrigation, were reported. The first case, an 80-year-old male was admitted with complaints of headache and stupor without any history of head trauma. CT revealed a left subdural hematoma with mixed density. Intractable facial convulsion occurred three days after admission. Single burr hole drainage was performed to remove the hematoma, and facial convulsion disappeared one week after the surgery. The second case, a 70-year-old male was admitted with complaints of consciousness disturbance without any history of head trauma. CT showed a right subdural hematoma with mixed density. The next day, he recovered consciousness and CT demonstrated shrinkage of the hematoma. However, his consciousness deteriorated again 11 days after admission, and CT revealed progression of the hematoma. We performed single burr hole drainage, and the next day, his neurological condition recovered. The third case, an 84-year-old female was admitted with complaints of consciousness disturbance without any history of head trauma. CT revealed a left subdural hematoma with mixed density. Single burr hole drainage was performed to remove the hematoma. She recovered completely and was discharged and return home 1 month after the surgery. Single burr hole drainage is less invasive than craniotomy. Our three cases indicate that this method may be one of the best methods for aged patients with acute spontaneous subdural hematoma which manifests mixed density in CT.