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。

Minimally Invasive Puncture and Drainage for Acute Traumatic Epidural Hematoma

Objective To investigate the efficacy of minimally invasive puncture and drainage for acute traumatic epidural hematoma. Methods From June 2009 to June 2012, with YL-1 disposable puncture needle, we performed minimally invasive puncture and drainage on totally 68 patients with acute traumatic epidural hematoma. The puncture point, direction and depth were determined by CT scan. Assisted by a drill, the disposable puncture needle was placed into the hematoma. After the hematoma was partially evacuated, urokinase （20 000- 50 000 U per 2- 5 ml PS） was injected to dissolve the remnant hematoma. CT scans were conducted dynamically to track the hematoma evacuation. The drainage was removed according to the clinical conditions and CT findings. Results The procedure was completed successfully in all the 68 patients. Complete removal confirmed by CT was achieved in 64 cases 2 -5 days later （2 days in 32 cases, 3 days in 22 cases, and 10 days in 5 cases）. Two cases showed active bleeding during the procedure and thus were converted to open surgery. After emergency puncture and vacation with this procedure, subsequent open surgery was conducted in two cases of brain hernia. After the surgery, headache was immediately relieved in 18 cases; numbness and weakness of the limbs disappeared immediately in 3 cases, and other symptoms were gradually improved in 3 - 5 days. Postoperative hospital stay was 12 days in average （ranged 7 - 15 days）. All the patients received a followed up for 3 -6 months, during which complete aphasia was found in 1 case, and mild intelligence decline in 4 cases, who was complicated with cerebral contusion. No patient died. Conclusion Minimally invasive puncture and drainage is convenient, rapid, minimally invasive, and effective for acute traumatic epidural hematoma.