出血型烟雾病急性期的微创治疗

摘要

目的：探讨微创术联合重组组织型纤溶酶原激活剂（rt-PA）治疗烟雾病相关脑出血急性期的可行性及有效性。方法：回顾性分析2012年9月至2014年9月我院收治并接受微创术联合 rt-PA 治疗的烟雾病所致脑出血患者，观察并分析其临床特点、手术效果、出血并发症及预后。改良的 Rankin 量表（mRS）评估预后。结果：共纳入5例患者，男1例，女4例，年龄31～56岁（平均44岁）。5例患者的血肿清除效果满意，平均达90%（84%～96%）。4例患者无出血并发症，平均随访11个月（1～22个月），3例功能恢复良好，1例仍有重度残疾。 1例患者出现了穿刺部位的出血伴蛛网膜下腔出血，7 d 后死于多脏器功能不全。结论：微创术联合rt-PA 液化引流血肿可用于出血型烟雾病相关脑出血的急性期治疗，能够快速清除血肿且不增加远期再出血风险，但需警惕穿刺损伤所致的再出血。%Objective: The object of this study was to evaluate the efficacy and safety of minimally-invasive surgery plus recombinant tissue plasminogen activator (rt-PA) for hemorrhage evacuation after acute hemorrhagic moyamoya disease. Methods: The patients who were diagnosed as moyamoya disease with intracerebral hemorrhage (ICH) and treated by minimally-invasive surgery plus rt-PA, were retrospectively analyzed. Modified Rankin scale (mRS) was used to evaluate prognosis. Results: Five patients were included for the analysis. They were 1 male and 4 females, with ages ranged from 31 to 56 years. All patients were treated by the surgery success-fully. Over 90% (84%~96%) ICH was removed at end of treatment evaluated based on serial CT. Hemorrhagic complications occurred in 1 patient. During the follow-up period (1~22 months),none had experienced a second episode of intracerebral bleeding. Three patients had a good recovery (mRS scores of 1 or 2) and 1 patient harbored moderately severe disability (mRS scores of 4). Subarachnoid hemorrhage and catheter tract bleeding occurred in one patient who died of multiple organ failure 7 days later. Conclusion: Minimally-invasive surgery plus rt-PA for hemorrhage evacuation was effective in acute hemorrhagic moyamoya disease. The postoperative hemorrhagic complications remained a concern.