CT监控下立体定向颅内血肿抽吸术的临床应用

目的 探讨在CT监控下立体定向脑内血肿清除术的临床应用价值。方法 将定向仪安装在CT床头侧并与CT坐标中心校验为同步，病人在手术室或直接在CT室钻孔，手术全过程在CT床上进行，至少行术前、术中和术毕3次监控扫描，并根据需要随时扫描观察动态效果或调整靶点。本组共860例，包括基底节血肿408例、丘脑－内囊后肢血肿136例、外囊血肿105例、脑叶血肿156例、脑干血肿40例、小脑血肿5例及脑室出血10例；抽吸术距发病时间自3h至14d。结果 血肿可随意抽出者586例，血肿较馥稠但可清除率大于50％者202例，可清除率在50％以下者68例，完全无法抽出4例；手术时间25－120min，平均45min；存活693例，死亡167例，对生存者进行日常生活能力测评（active day life,ADL),ADL 1-2级者378例，ADL3级者166例，ADL4级者107例，ADL5级者28例，失访14例。结论 CT监控下立体定向脑内血肿抽吸术，是1种值得推广的安全、精确和简捷的脑内血肿治疗方法。

Clinical application of CT-controlled stereotactic aspiration for intracerebral hematoma

Objective To evaluate the clinical application of CT-controlled stereotactic aspiration for intracerebral hematoma. Methods CT-guided stereotactic system was installed on the CT bed, and checked against a standard of the coordinate. According to controlled CT scan, the target can be adjusted at any time in the operation. 860 patients with cerebral hematoma underwent CT-controlledstereotactic aspiration. Of the 860 cases, basal ganglion hematoma was present in 408, thalamus and posterior limb of internal capsule hematoma in 136, cerebral lobe hematoma in 261, cerebellar hematoma in 5, ventricular hemorrhage in 10, midbrain and pons hemorrhage in 37, and medulla hemorrhage in 3. Results Easy drainage of hematoma by aspiration was achieved in 586 cases, stickiness of hematoma with clearing away more than 50% was performed in 202 and less than 50% in 68. The operation duration ranged from 25 to 120 minutes (average 45 minutes). 693 cases survived and 167 cases died. According to the evaluation by active day life (ADL) after 3 months in survivors, ADL 1-2, ADL 3, ADL 4, and ADL 5 results were achieved in 378 cases, 166 cases, 107 cases, and 28 cases, respectively. In addition, 14 cases were lost beyond recall. Conclusion CT-controlled stereotactic aspiration for intracerebral hematoma is a handy, less invasive, and safe procedure with high accuracy and curative effect, it is worth while popularizing the procedure.