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中华神经创伤外科电子杂志

中华神经创伤外科电子杂志 ›› 2015, Vol. 01 ›› Issue (05) : 21 -24. doi: 10.3877/cma.j.issn.2095-9141.2015.05.006

所属专题： 文献；

临床研究

脑室镜联合腰大池置管持续引流治疗重度原发性脑室出血
应建有1,†(), 谭占国1, 袁波1   
  1. 1. 462000　漯河，河南省漯河市中心医院神经外科
  • 收稿日期:2015-05-21 出版日期:2015-10-15
  • 通信作者: 应建有

Treatment of severe primary intraventricular hematoma by ventriculoscope and continued lumbar cerebrospinal fluid drainage

Jianyou Ying1,†(), Zhanguo Tan1, Bo Yuan1   

  1. 1. Department of Neurosurgery, Central Hospital of Luohe City, Henan 462000, China
  • Received:2015-05-21 Published:2015-10-15
  • Corresponding author: Jianyou Ying
  • About author:
    Corresponding author: Ying Jianyou, Email:
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应建有, 谭占国, 袁波. 脑室镜联合腰大池置管持续引流治疗重度原发性脑室出血[J]. 中华神经创伤外科电子杂志, 2015, 01(05): 21-24.

Jianyou Ying, Zhanguo Tan, Bo Yuan. Treatment of severe primary intraventricular hematoma by ventriculoscope and continued lumbar cerebrospinal fluid drainage[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2015, 01(05): 21-24.

目的

评价脑室镜联合腰大池置管持续引流治疗重度脑室出血的疗效。

方法

回顾性分析2007年7月至2015年10月在漯河市中心医院神经外科收治的62例重度原发性脑室出血患者的临床资料，按时间先后顺序分为2组，其中A组(2010年5月以前)27例采用脑室钻孔引流及间断腰穿治疗，B组(2010年5月以后)35例应用脑室镜及腰大池置管持续引流治疗，分析患者术后48 h的血肿清除率及术后6个月患者日常生活能力ADL分级。

结果

(1)A组27例中1例血肿清除>90%，9例血肿清除60%-90%，17例血肿清除<60%；B组35例中15血肿清除>90%，18例血肿清除60%-90%，2例血肿清除<60%，两组血肿清除率分布差异有统计学意义(P<0.01)。(2)术后6个月随访，A组中ADLⅠ级5例，Ⅱ级8例，Ⅲ级6例，Ⅳ级6侧，Ⅴ级2例，恢复良好(ADLⅠ~Ⅲ级)有效率70.37%；B组中ADLⅠ级16例，Ⅱ级10例，Ⅲ级5例，Ⅳ级3例，Ⅴ级1例，恢复良好(ADLⅠ~Ⅲ级)有效率88.57%，两组间差异有统计学意义(P<0.01)。

结论

应用脑室镜联合腰大池置管持续引流治疗重度原发性脑室出血具有血肿清除率高、后遗症发生率低等优点，是治疗重度原发性脑室出血较佳的方法。

关键词: 脑室镜, 腰大池置管持续引流, 重度原发性脑室出血
Objective

To evaluate the efficacy of ventriculoscope and continued lumbar cerebrospinal fluid drainage in the treatment of severe primary intraventricular hematoma.

Methods

Sixty-two patients with severe primary intraventricular hematoma patients in Luohe Central Hospital from July 2007 to November 2015 were retrospectively analyzed and divided into group A(n=27, before May 2010)and group B (n=35, after May 2010) according to the time sequence. Twenty-seven patients in group A were treated with ventriculopuncture and intermittent lumbar puncture. Thirty-five patients in group B were treated with ventriculoscope and continued lumbar cerebrospinal fluid drainage. Hematoma evacuation rate 48 hours after operation and ADL grades 6 months after operation were compared.

Results

(1)Hematoma evacuation rate >90% were found in 1 cases in group A 48 hours after operation, and hematoma evacuation rate 60%-90% were found in 9 cases, hematoma evacuation rate<60% were found in 17 cases; Hematoma evacuation rate >90% were found in 15 cases in group A 48 hours after operation, and hematoma evacuation rate 60%-90% were found in 18 cases, hematoma evacuation rate <60% were found in 2 cases, the differences were statistically significant(P<0.01). (2)6 months after operation, in group A, 5 cases of ADL grade Ⅰ, 8 cases of ADL grade Ⅱ, 6 cases of ADL grade Ⅲ, 6 cases of ADL grade Ⅳ, 2 case of ADL grade Ⅴ, good recovery rate was 70.37%; In group B, 16 cases of ADL grade Ⅰ, 10 cases of ADL grade Ⅱ, 5 cases of ADL grade Ⅲ, 3 cases of ADL grade Ⅳ, 1 case of ADL grade Ⅴ, good recovery rate was 88.57%, the difference was statistically significant (P<0.01).

Conclusion

Ventriculoscope and continued lumbar cerebrospinal fluid drainage for severe primary intraventricular hematoma is a better surgical treatment because of its effective hematoma evacuation and excellent postoperative outcome.

Key words: Ventriculoscope, Continued lumbar cerebrospinal fluid drainage, Severe primary intraventricular hematoma
表1 术后48 h两组血肿清除率比较
组别 例数 血肿清除率
>90% 90%~60% <60%
A组 27 1 9 17
B组 35 15 18 2
χ2值 ? 5.002 6.856 12.887
P值 ? 0.002 0.001 0.000
表2 两组疗效比较
组别 例数 术后6个月ADL评分 优良率
Ⅰ Ⅱ Ⅲ Ⅳ Ⅴ
A组 27 5 8 6 6 2 70.4%
B组 35 16 10 5 3 1 88.6%
Z值 ? 42.211 ?
P值 ? 0.002 ?
[1]
Chung JC, Kim SM, Sade B, et al. Endoscope-assisted microsurgical removal of an epidermoid tumor within the cavernous sinus[J]. Yonsei Med J, 2012, 53(6): 1216-1219.
[2]
Auer LM, Ascher PW, Heppner F, et al. Does acute endoscopic evacuation improve the outcome of patients with spontaneous intracerebral hemorrhage[J]. Eur Neurol, 1985, 24(4): 254-261.
[3]
Qiu Y, Lin Y, Tian T, et al. Hypertensive intracranial hematomas:endoscopic-assisted keyhole evacuation and application of patent viewing dissector[J]. Chin Med J, 2003, 116(2): 195-199.
[4]
李在强，李新纲，邵毅,等.神经内镜在脑室出血治疗中的临床应用[J].中华神经外科杂志, 2005, 21(11): 672-674.
[5]
张亚卓，邸虓,主编.内镜神经外科学[M].北京:人民卫生出版社, 2012: 11-12.
[6]
杜郭佳，巴吐鲁呼，朱国华,等.脑室镜治疗脑室出血的临床疗效[J].中华神经外科杂志, 2012, 28(11): 1124-1126.
[7]
王建荣.脑室镜下清除脑室内积血[J].医学美学美容（中旬刊）, 2014, (4): 386-386.
[8]
虞露立，郭永梅，詹建,等.脑室镜手术与传统开颅手术治疗脑室出血的临床对比研究[J].中国医师进修杂志, 2012, 35(14): 59-61.
[9]
李育平，张恒柱，杜任飞,等.神经内镜对比传统脑室外引流治疗脑室出血的Meta分析[J].中国神经精神疾病杂志, 2013, 39(3): 135-141.
[10]
林晓，张超元.脑室镜手术与传统开颅手术治疗脑室出血的疗效对比分析[J].现代预防医学, 2010, 37(20): 3966-3970.
[11]
刘军，张传东，仇洪,等.脑室镜联合脑室外引流术治疗原发性脑室出血的疗效分析[J].吉林医学, 2014, (36): 8009-8011.
[12]
吴春富，陆华，朱爱华,等.自制神经内镜辅助器械治疗高血压性脑室出血[J].中华神经医学杂志, 2011, 10(3): 308-310.
[13]
张琦玮，王铁峰.侧脑室钻孔引流结合脑室镜治疗10例大量脑室出血的疗效[J].求医问药（学术版）, 2012, 10(8): 24.
[14]
李罡，苏治国，颜荣,等.经胼胝体入路显微镜下血肿清除术治疗脑室出血的疗效观察[J].山东医药, 2015, (4): 48-50.
[15]
马涛，刘家传，张永明,等.原发性脑室出血伴脑室铸型的微创治疗[J].医学信息, 2014, (20): 204-205.
[16]
吕正文，张明然，李孟考,等.神经内窥镜控制手术、小骨窗开颅手术与脑室穿刺尿激酶灌注引流治疗高血压脑室出血的对比观察[J].中国综合临床, 2011, 27(11): 1192-1195.
[17]
吕正文，宁波，张明然,等.治疗高血压脑出血破入脑室微创术式的临床研究[J].泰山医学院学报, 2010, 31(11): 828-830.
[18]
宋书欣，程祖珏，涂伟,等.神经内镜血肿清除治疗烟雾病脑室出血[J].中国医师杂志, 2015, 17(9): 1417-1418.
[19]
冯胜利，孙有树，魏振宇,等.脑室镜治疗自发性脑室内出血126例临床研究[J].实用医药杂志, 2015, (5): 437-438.
[20]
杜志君，吴杰，王建光,等.经胼胝体-侧脑室手术入路治疗重型原发性脑室出血[J].中国老年学杂志, 2006, 26(1): 43-44.
[21]
杜昌旺，王茂德，宋锦宁,等.神经内镜手术与钻孔引流治疗高血压脑室出血66例效果比较[J].中国医药导报, 2013, 10(22): 54-56.
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