CAJ | 학술논문

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.
목적 탐토편휴식두로CT도항하쇄공미창수술치료막상고혈압뇌출혈적료효급안전성. 방법 재북경군구총의원부속팔일뇌과의원자2010년1월지2012년12월련속수치적고혈압뇌출혈치혼미환자중,선택출혈량유수술지정(출혈량24～90 mL)적35례환자행편휴식두로CT도항하쇄공미창수술.채용격랍사가혼미평분(GCS)화개량적Rankin평분(mRS)평고환자술전술후적신경계통상태.수방6개월후채용격랍사가예후평분(GOS)평개환자적전귀. 결과 35례환자급진입원도수술적평균시간위(11.22±6.37)h,CT소묘평균시간위(19.00±13.11) min,수술평균시간위(108.49±26.61) min.혈종전부혹근전부청제(청제솔＞90％)자32례(91.43％),혈종평균청제솔위96.9％(77.9％～99.4％).술후GCS평분[0～15분(중위수14분)]화mRS평분[0～6분(중위수3분)]균교술전[GCS평분위3～15분(중위수9분)；mRS평분위2～5분(중위수4분)]유명현적개선.수방6개월후57.1％(20/35)적환자예후량호(GOS평분4～5분),2례환자사망. 결론 편휴식두로CT도항하쇄공미창혈종청제술불부가감소수술손상,이차가제고수술효솔급혈종청제솔,종이유효개선환자적예후.편휴식두로CT능쾌속급여술전도항,대고혈압뇌출혈환자적수술치료가제공흔대적방조.
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.