摘要： 探讨微创穿刺脑室外引流术联合早期腰大池引流术对第三和第四脑室血肿清除的效果。共54 例脑室出血患者分别施行微创穿刺脑室外引流术、脑室内尿激酶灌洗联合早期腰大池引流术（联合治疗组）或单纯微创穿刺脑室外引流术。对两组患者术后第三和第四脑室血肿清除率进行比较显示，术后3 d 时联合治疗组血肿清除率> 85%的患者占59.26%（16/27），高于对照组的22.22%（6/27；χ² = 7.670，P = 0.006）；术后2 ~ 3 d 联合治疗组第三和第四脑室血肿清除速度高于对照组（t = 3.475，P = 0.001）。术后3 个月时联合治疗组治疗有效率为81.48%（22/27），高于对照组的55.56%（15/27；χ² =4.207，P = 0.040）。提示微创穿刺脑室外引流术联合早期腰大池引流术能够加快第三和第四脑室血肿清除速度，改善脑室出血患者预后。

关键词: 脑出血, 脑室, 引流术, 外科手术, 微创性

Abstract: This paper aims to evaluate the effect of minimally invasive puncture external ventricular drainage (EVD) combined with early lumbar drainage (LD) for clearance of hematoma in the third and fourh ventricles in patients with intraventricular hemorrhage (IVH). Fifty-four IVH patients were analyzed. Twenty-seven patients in combined treatment group were treated with EVD and early LD while others in control group were treated with EVD only. Urokinase was administered into ventricles in all patients. The difference of hematoma clearance rate between 2 groups was compared. Long-term therapeutic effect of the two methods was also evaluated. The results showed that in combined treatment group, cases with 3-day clearance rate over 85% occupied 59.26% (16/27), which was higher than that of control group (22.22%, 6/27; χ² = 7.670, P = 0.006). Two to three days after surgery, hematoma declined more quickly in combined treatment group comparing with control group (t = 3.475, P =0.001). Long-term effective rate of treatment in combined treatment group was 81.48% (22/27), which was higher than that of control group (55.56%, 15/27; χ² = 4.207, P = 0.040). Minimally invasive puncture EVD combined with early LD could increase hematoma clearance rate in the third and fourth ventricles. It is helpful for improving the prognosis of IVH patients.

Key words: Cerebral hemorrhage, Cerebral ventricles, Drainage, Surgical procedures, minimally invasive