微骨瓣额中回入路治疗重型脑室出血.pdfVIP

天津医药2014年2月第42卷第2期 179 应用研究 微骨瓣额中回入路治疗重型脑室出血 崔永华 夏咏本 张立勇 韩 清 陈恒林 【摘要】 目的 探讨微骨瓣额中回入路在重型脑室出血中的应用价值。方法 回顾性分析21例微骨瓣额中回 入路治疗重型脑室出血的临床资料。结果 术后脑室内外血肿清除满意，改善了GCS评分、脑室积血Graeb评分。 主要并发症：弥漫性脑肿胀1例，脑血管痉挛3例，颅内感染1例，肺部感染7例。随访1~6个月，按ADL分级恢复良好 5例，中度残疾9例，重度残疾3例，植物生存1例，死亡3例。结论 微骨瓣经额中回入路可有效清除脑室内外血肿， 及时解除梗阻性脑积水，减轻继发性脑损害，改善患者的预后。 【关键词】 脑出血；脑室；显微外科手术；额；血肿；引流术 【中图分类号】 R651 【文献标识码】 B 【DOI】 10.3969/j.issn.0253-9896.2014.02.024 TheTreatmentofSevereIntraventricularHematomathroughMidfrontalKeyholeApproach CUIYonghua,XIAYongben,ZHANGLiyong,HANQing,CHENHenglin DepartmentofNeurosurgery,TheAffiliatedJianhuHospitalofNantongUniversity,Jianhu224700,China [Abstract] Objective Toevaluatetheclinicalvalueofmidfrontalkeyholeapproachforthetreatmentofsevereintra⁃ ventricularhematoma.Methods Theclinicaldataof21casesofsevereintraventricularhemorrhagethroughmidfrontalkey⁃ holeapproachwereanalyzedretrospectively. Results Bothinsideandoutsideintraventricularhematomaweresatisfied cleared.TheGCSscoreandintraventricularhemorrhageGraebscorewereimproved.Therewerecomplicationsafteropera⁃ tionincluding 1patientwithdiffusebrainswelling, 3patientswithcerebralvasospasm, 1patientwithintracranialinfection, andsevenpatientswithpulmonaryinfection.Follow-upschedulesincluded 1-6months.AccordingtoADLscore,5patients recoveredwell,9patientsweremoderatelydisabled,3wereseverelydisabled, 1wasinavegetativestateand3died.Conclu⁃ sion Theintraventricularhematomacanberemovedthroughmidfrontalkeyholeapproach.Theobstructivehydrocephalus canberelieved,thesecondarybraindamagewasreducedandtheprognosiswasimprovedinpatients. [Keywords] cerebralhemorrhage；cerebralventricles；microsurgery；forehead；hematoma；drainage 脑室出血发病急骤，常较早出现下丘脑