摘要：

目的 探讨一次性脑立体定位仪辅助下血肿穿刺置管引流术治疗基底节区出血的有效性和安全性。方法 2017 年 1 月-2018 年 5 月纳入 58 例出血量 25.52 ~ 39.98 ml的基底节区出血患者，随机接受一次性脑立体定位仪辅助下血肿穿刺置管引流术（Locator 组，29 例）和头部 CT 联合“十”字激光发射器辅助下血肿穿刺置管引流术（CT + laser 组，29 例），计算眶耳线水平面、经双侧外耳孔冠状平面和正中矢状平面理论置管靶点与引流管末端实际位置的相对距离差值，记录手术时间、术中置管次数和术后尿激酶应用次数，测量残留血肿量并计算拔管前血肿残留比例，记录颅内血肿扩大和颅内感染发生率。结果 Locator 组患者眶耳线水平面（t = -17.369，P = 0.000）、经双侧外耳孔冠状平面（t = -18.381，P = 0.000）和正中矢状平面（t = -13.540，P = 0.000）穿刺误差均低于 CT + laser 组，术中置管次数（Z = -2.565，P = 0.010）和术后尿激酶应用次数（Z = -2.434，P = 0.015）均少于 CT + laser组。两组患者各观察时间点残留血肿量差异有统计学意义（F = 528.850，P = 0.000），而 Locator组与 CT + laser组患者残留血肿量差异无统计学意义（F = 0.000，P = 0.991）；进一步计算拔管前血肿残留比例，Locator 组达优秀比例高于 CT + laser 组且差异有统计学意义（Z = -3.660，P = 0.000）。两组颅内血肿扩大（校正χ² = 0.186，P = 0.666）和颅内感染（校正χ² = 0.518，P = 0.472）发生率差异无统计学意义。结论 一次性脑立体定位仪辅助下血肿穿刺置管引流术操作简便、安全，穿刺精度和引流效率较高。 

关键词: 脑出血, 基底神经节, 立体定位技术, 引流术

Abstract:

Objective To investigate the efficacy and safety of hematoma puncture and catheter drainage assisted by a disposable stereotaxic locator in the treatment of basal ganglia hemorrhage. Methods From January 2017 to May 2018, a total of 58 cases of basal ganglia hemorrhage with the hematoma volume of 25.52-39.98 ml were randomly divided into 2 groups: Locator group (N = 29) underwent hematoma puncture and catheter drainage assisted by a disposable stereotaxic locator and CT + laser group (N = 29) underwent hematoma puncture and catheter drainage assisted by CT positioning with the aid of a cross laser transmitter. Calculate the relative distance difference between preoperatively designed target and actual end on the horizontal plane of orbitomeatal line, coronal plane via bilateral porus acusticus externus and midsagittal plane. Record operation time, the numbers of intraoperative catheter placement and postoperative use of urokinase. Measure the volume of residual hematoma, calculate the proporation of residual hematoma before extubation. Record the occurrence rate of enlarged hematoma and intracranial infection. Results Locator group performed better than CT + laser group on puncture accuracy on the horizontal (t = -17.369, P = 0.000), coronal (t = -18.381, P = 0.000) and midsagittal plane (t = -13.540, P = 0.000) respectively. Locator group accomplished the puncture with less numbers of catheter placement (Z = -2.565, P = 0.010) and less use of urokinase after surgery (Z = -2.434, P = 0.015) than CT + laser group. There was significant difference on the volume of residual hemotoma among different timepoints in 2 groups (F = 528.850, P = 0.000), while there was no significant difference on the volume of residual hemotoma between 2 groups (F = 0.000, P = 0.991). The proportion of patients in Locator group with excellent treatment effect (defined as percentage of residual hemotma in initial hematoma volume before extubation ≤ 15% ) was significantly higher than that in CT + laser group (Z = -3.660, P = 0.000). There were no significant differences on the occurence rate of enlarged hematoma (adjusted χ² = 0.186, P = 0.666) and intracranial infection (adjusted χ² = 0.518, P = 0.472) between 2 groups. Conclusions The disposable stereotaxic locator is simple to operate, and helps to improve the therapeutic effect of hematoma puncture and catheter drainage with much better accuracy of catheter placement, higher efficacy of drainage of hematoma and less incidence of complications.

Key words: Cerebral hemorrhage, Basal ganglia, Stereotaxic techniques, Drainage