Chen Xiaonan, Chen Wenya, Ma Aijin, Wu Xianghong, Zheng Jiangang, Yu Xiangrong, Wang Yi-Xiang J, Wang Daoyuan
Department of Neurology, Wujin People's Hospital, affiliated to Jiangsu University, Changzhou, PR China.
Br J Neurosurg. 2011 Jun;25(3):369-75. doi: 10.3109/02688697.2010.520765. Epub 2010 Sep 28.
The options for managing spontaneous intracerebral haemorrhage (ICH) include conservative treatment, surgical removal of the haematoma and minimally invasive treatment with clot aspiration and subsequent fibrinolytic therapy. The discussion over which treatment is best for ICH remains controversial and management of patients with spontaneous ICH continues to be a challenge. The purpose of this study is to investigate the feasibility and safety of frameless stereotactic aspiration and subsequent fibrinolytic therapy for the treatment of spontaneous ICH.
Patients with spontaneous supratentorial ICH were treated by a frameless stereotactic aspiration using the YL-1 type of intracranial haematoma puncture needle, followed by subsequent fibrinolytic therapy with urokinase.
Forty-eight patients were enrolled in the study. The median age was 65 years (range, 40-79). The median initial Glasgow Coma Scale (GCS) was 10 (range 6-14). The mean initial haematoma volume was 56.5 cm(3). Initial ICH volume was reduced by an average of 75% (range 50-90%). Ten patients (20.8%) died before hospital discharge. By the 3-month follow-up, another two patients had died, resulting in an overall mortality of 25.0%. For the primary end point, a good outcome (3-month GOS score >3) rate was noted in 41.7% of the patients. No intraoperative death was observed in this study. There were a total of 14 (29.2%) procedure-related complications, with an overall re-bleeding rate of 10.4%.
Frameless stereotactic aspiration using the YL-1 type of intracranial haematoma puncture needle and subsequent fibrinolytic therapy for the treatment of spontaneous ICH is a simple and safe procedure with low re-bleeding rate and mortality.
自发性脑出血（ICH）的治疗选择包括保守治疗、手术清除血肿以及采用凝块抽吸和后续纤溶治疗的微创治疗。关于哪种治疗对ICH最为合适的讨论仍存在争议，自发性ICH患者的管理仍然是一项挑战。本研究的目的是探讨无框架立体定向抽吸及后续纤溶治疗用于治疗自发性ICH的可行性和安全性。
采用YL-1型颅内血肿穿刺针，对自发性幕上ICH患者进行无框架立体定向抽吸，随后用尿激酶进行纤溶治疗。
48例患者纳入本研究。中位年龄为65岁（范围40 - 79岁）。初始格拉斯哥昏迷量表（GCS）中位数为10分（范围6 - 14分）。初始血肿平均体积为56.5 cm³。初始ICH体积平均减少75%（范围50% - 90%）。10例患者（20.8%）在出院前死亡。至3个月随访时，又有2例患者死亡，总死亡率为25.0%。对于主要终点，41.7%的患者获得了良好结局（3个月GOS评分>3）。本研究未观察到术中死亡。共有14例（29.2%）与操作相关的并发症，总再出血率为10.4%。
采用YL-1型颅内血肿穿刺针进行无框架立体定向抽吸及后续纤溶治疗自发性ICH是一种简单且安全的操作，再出血率和死亡率较低。
