神經內鏡手術治療高血壓腦出血的研究進展

石爽 張彪 楊剛 張正保 楊彪 牛文勇 鄧偉 覃川

[摘要] 高血壓腦出血是所有腦卒中亞型最常見的一種，具有高致死率和致殘率，其預后與患者的年齡、出血部位、出血量、出血速度、手術時機、手術方式以及是否口服抗凝藥物等因素密切相關。在嚴格掌握手術適應證和手術時機的前提下，與局麻下微創穿刺加尿激酶溶解術（包括立體定向、CT引導的硬通道與軟通道穿刺）及開顱顯微血腫清除手術比較，神經內鏡血腫清除術既減少了對腦組織造成的進一步的創傷，也更加徹底地清除腦內血腫和止血，具有更加微創、療效更好優勢。目前，神經內鏡在高血壓腦出血手術治療中的輔助手段包括CT引導、立體定向引導、B超輔助、神經導航輔助及手機軟件輔助等。各種不同的輔助手段的使用使神經內鏡對血腫的定位更加精確，減少了對腦組織的創傷，提高了患者的預后。本文對目前神經內鏡治療高血壓腦出血的輔助手段及各自手術方法與特點進行了總結。

[關鍵詞] 高血壓腦出血;神經內鏡;手術方法;輔助方法

[中圖分類號] R651.12? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 1673-7210（2019）07（c）-0051-04

Advances in neuroendoscopic surgery for hypertensive intracerebral hemorrhage

SHI Shuang1? ?ZHANG Biao1? ?YANG Gang2? ?ZHANG Zhengbao1? ?YANG Biao1? ?NIU Wenyong1? ?DENG Wei1? ?QIN Chuan1

1.Department of Neurosurgery， Dazu District People′s Hospital in Chongqing City， Chongqing? ?402360， China; 2.Department of Neurosurgery， the First Affiliated Hospital of Chongqing Medical University， Chongqing? ?400016， China

[Abstract] Hypertensive intracerebral hemorrhage is the most common subtype of stroke with high mortality and disability. Its prognosis is closely related to the age， location， volume， speed of bleeding， timing of operation， mode of operation and whether or not to take anticoagulants orally. On the premise of strictly grasping the indications and timing of operation， compared with local anesthesia minimally invasive puncture plus urokinase lysis （including stereotactic， CT-guided hard and soft channel puncture） and craniotomy microhematoma removal surgery， neuroendoscopic hematoma removal surgery not only reduces further trauma to brain tissue， but also can More thorough removal of intracerebral hematoma and hemostasis， with more minimally invasive， better efficacy advantages. At present， the assistant means of neuroendoscopy in the surgical treatment of hypertensive intracerebral hemorrhage include CT guidance， stereotactic guidance， B-ultrasound assistance， neuronavigation assistance and mobile phone software assistance. The use of various assistant means makes the neuroendoscopy more accurate in locating the hematoma， reduces the trauma to brain tissue and improves the prognosis of patients. This paper summarizes the assistant methods and their respective operative methods and characteristics of neuroendoscopy in the treatment of hypertensive intracerebral hemorrhage.

[Key words] Hypertensive intracerebral hemorrhage; Neuroendoscopy; Surgical methods; Instrument guidance

高血壓腦出血是高血壓病最嚴重的并發癥之一，是中國腦卒中死亡的首要原因[1]。顱內腦底的穿支動脈直接從大血管上的垂直發出，因此管壁承受的血壓較大，然而高血壓病常導致小動脈的血管壁發生玻璃樣或纖維樣變性，嚴重降低穿支血管彈性，增加其管壁的脆性，因此腦血管常常因情緒激動、過度勞累等因素而誘發破裂出血，且常見于基底節區（殼核、尾狀核、丘腦），依次是腦葉、小腦和腦橋等部位。……