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目的总结运用微创手术治疗丘脑出血,探讨其合理治疗方法,以提高患者的救治水平。方法本组选择50例丘脑出血患者,其出血量>10ml以上、年龄50～74岁,根据血肿大小,是否破入脑室等,采用YL-1型颅内血肿粉碎穿刺针,分别以单纯血肿穿刺引流、单纯脑室穿刺引流等。结果血肿清除率达75%～95%,血肿清除或基本清除时间3～6天,平均4天,平均住院22天。死亡10例,病死率20%。生存病例术后6个月随访评定疗效,ADL1恢复日常生活7例,ADL2生活自理11例,ADL3生活需要帮助11例,ADL4卧床不起有意识10例,ADL5植物状态1例。结论YL-1型颅内血肿穿刺清除技术治疗丘脑血肿,创伤轻微,不增加深部脑组织结构的损伤,血肿腔内置管进行血肿抽吸加血肿溶解技术,清除血肿可靠。手术应尽量早期施行,合理必要的脑室引流,积极防治并发症。
Objective To summarize the use of minimally invasive surgery in the treatment of thalamic hemorrhage and explore its reasonable treatment to improve the level of treatment of patients. Methods The group of 50 patients with thalamic hemorrhage, the amount of bleeding> 10ml or more, aged 50 to 74 years old, according to the size of the hematoma, is broken into the ventricle, using YL-1 intracranial hematoma crushed puncture needle were hematoma Drainage, simple intraventricular puncture and drainage. Results Hematoma clearance rate of 75% to 95%, hematoma removal or clearance time of 3 to 6 days, an average of 4 days, the average hospitalization of 22 days. Death in 10 cases, case fatality rate of 20%. Survival cases were evaluated after 6 months of follow-up. ADL1 returned to 7 cases of daily living, 11 cases of ADL2 self-care, 11 cases of ADL3 need help, 10 cases of ADL4 bedridden consciousness and 1 case of ADL5. Conclusions YL-1 intracranial hematoma puncture and removal technique is effective in treatment of thalamic hematoma with minimal trauma and no damage to deep brain tissue. Hematoma aspiration and hematoma lysis are used to remove hematoma. Surgery should be implemented as early as possible, ventricular drainage necessary and effective prevention and treatment of complications.