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武汉科技大学附属天佑医院神经外科,湖北 武汉 430064
郐国虎,E-mail:guiguohu@163.com
收稿:2024-11-20,
纸质出版:2025-11-25
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陈煜,郐国虎.不同手术方式治疗原发性脑干出血的研究进展[J].局解手术学杂志,2025,34(11):1016-1020.
CHEN Yu,GUI Guo-hu.Research progress on different surgical methods in the treatment of primary brainstem hemorrhage[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2025,34(11):1016-1020.
陈煜,郐国虎.不同手术方式治疗原发性脑干出血的研究进展[J].局解手术学杂志,2025,34(11):1016-1020. DOI: 10.11659/jjssx.11E024112.
CHEN Yu,GUI Guo-hu.Research progress on different surgical methods in the treatment of primary brainstem hemorrhage[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2025,34(11):1016-1020. DOI: 10.11659/jjssx.11E024112.
原发性脑干出血(PBSH)是指排除外伤后,脑干组织内的血管破裂引起的出血。脑干是人体的生命活动中枢,且胶质细胞少,对血肿的吸收较慢,因此PBSH具有发病急、病情进展极其迅速、病死率极高的特点;同时,因脑干结构复杂、功能重要,长期以来被视为手术禁区。近些年,随着成像技术及手术设备的高速发展,显微外科技术和术中导航在临床上得到了广泛应用,神经外科医生对脑干区域解剖结构的认识越来越充分,脑干手术的成功率因此得到了大幅提高。本文现就不同手术方式治疗PBSH的研究进行综述,以期为PBSH的手术治疗提供更全面的参考。
Primary brainstem hemorrhage (PBSH) refers to bleeding caused by the rupture of blood vessels within the brainstem tissue after excluding trauma.The brainstem is the central hub of human life activities,with fewer glial cells and slower absorption of hematomas.Therefore,PBSH has the characteristics of acute onset and extremely rapid disease progression,as well as high mortality rate.Due to the complex structure and important function of the brainstem, it has long been regarded as a surgical exclusion zone.In recent years,with the rapid development of imaging technology and surgical equipment,microsurgical techniques and intraoperative navigation have been widely used in clinical practice.Neurosurgeons have gained an increasingly thorough understanding of the anatomical structure of the brainstem region, which has significantly increased the success rate of brainstem surgeries.This article reviews the research on different surgical methods for treating PBSH,in order to provide a more comprehensive reference for the surgical treatment of PBSH.
Chen L , Chen T , Mao G , et al . Clinical neurorestorative therapeutic guideline for brainstem hemorrhage (2020 China version) [J]. J Neurorestoratol , 2020 , 8 ( 4 ): 232 - 240 . doi: 10.26599/JNR.2020.9040024 http://dx.doi.org/10.26599/JNR.2020.9040024 .
王军 , 王晓峰 , 张宏兵 . 原发性脑干出血的临床分析 [J]. 中国实用神经疾病杂志 , 2013 , 16 ( 22 ): 61 - 62 .
Zheng WJ , Shi SW , Gong J . The truths behind the statistics of surgical treatment for hypertensive brainstem hemorrhage in China:a review [J]. Neurosurg Rev , 2022 , 45 ( 2 ): 1195 - 1204 . doi: 10.1007/s10143-021-01683-2 http://dx.doi.org/10.1007/s10143-021-01683-2 .
中华医学会神经外科学分会脑血管病学组 , 中国医师协会神经外科医师分会脑血管外科学组 . 原发性脑干出血诊治中国神经外科专家共识 [J]. 中华医学杂志 , 2022 , 102 ( 15 ): 1068 - 1075 . doi: 10.3760/cma.j.cn112137-20211228-02913 http://dx.doi.org/10.3760/cma.j.cn112137-20211228-02913 .
王荣贵 , 刘昊 , 孙前 , 等 . 二合一复合手术治疗原发性脑干出血的体会及文献复习 [J]. 卒中与神经疾病 , 2024 , 31 ( 2 ): 206 - 209 . doi: 10.3969/j.issn.1007-0478.2024.02.016 http://dx.doi.org/10.3969/j.issn.1007-0478.2024.02.016 .
Pustilnik HN , Fontes JHM , Porto Junior S , et al . Stereotactic aspiration versus conservative management for primary brainstem hemorrhage:a systematic review and meta-analysis [J]. Clin Neurol Neurosurg , 2024 , 246 : 108583 . doi: 10.1016/j.clineuro.2024.108583 http://dx.doi.org/10.1016/j.clineuro.2024.108583 .
Chen P , Yao H , Tang X , et al . Management of primary brainstem hemorrhage:a review of outcome prediction,surgical treatment,and animal model [J]. Dis Markers , 2022 , 2022 : 4293590 . doi: 10.1155/2022/4293590 http://dx.doi.org/10.1155/2022/4293590 .
游潮 , 陶传元 . 原发性脑干出血诊断与治疗历史、现状与未来 [J]. 中国现代神经疾病杂志 , 2021 , 21 ( 2 ): 71 - 75 . doi: 10.3969/j.issn.1672-6731.2021.02.002 http://dx.doi.org/10.3969/j.issn.1672-6731.2021.02.002 .
Chen LH , Li FJ , Zhang HT , et al . The microsurgical treatment for primary hypertensive brainstem hemorrhage:experience with 52 patients [J]. Asian J Surg , 2021 , 44 ( 1 ): 123 - 130 . doi: 10.1016/j.asjsur. 2020.04.016 http://dx.doi.org/10.1016/j.asjsur.2020.04.016 .
Jang JH , Song YG , Kim YZ . Predictors of 30-day mortality and 90-day functional recovery after primary pontine hemorrhage [J]. J Korean Med Sci , 2011 , 26 ( 1 ): 100 - 107 . doi: 10.3346/jkms.2011. 26.1.100 http://dx.doi.org/10.3346/jkms.2011.26.1.100 .
陈立华 , 魏群 , 徐如祥 , 等 . 原发性高血压脑干出血的微创手术治疗 [J]. 临床神经外科杂志 , 2015 , 12 ( 5 ): 349 - 353 . doi: 10.3969/j.issn.1672-7770.2015.05.008 http://dx.doi.org/10.3969/j.issn.1672-7770.2015.05.008 .
刘宗惠 . 脑立体定向技术临床应用新进展 [J]. 中华神经外科疾病研究杂志 , 2003 , 2 ( 1 ): 1 - 3 . doi: 10.3969/j.issn.1671-2897.2003.01.001 http://dx.doi.org/10.3969/j.issn.1671-2897.2003.01.001 .
Spiegel EA , Wycis HT , Marks M , et al . Stereotaxic apparatus for operations on the human brain [J]. Science , 1947 , 106 ( 2754 ): 349 - 350 . doi: 10.1126/science.106.2754.349 http://dx.doi.org/10.1126/science.106.2754.349 .
Kall BA . Computer and imaging technology's impact on stereotactic neurosurgery:a 1987-1991 update [J]. Stereotact Funct Neurosurg , 1992 , 58 ( 1/4 ): 90 - 93 . doi: 10.1159/000098978 http://dx.doi.org/10.1159/000098978 .
Bergström M , Greitz T . Stereotaxic computed tomography [J]. AJR Am J Roentgenol , 1976 , 127 ( 1 ): 167 - 170 . doi: 10.2214/ajr.127.1. 167 http://dx.doi.org/10.2214/ajr.127.1.167 .
李岩 , 纪乐 , 陈凌友 , 等 . 立体定向软通道与硬通道抽吸手术治疗原发性脑干出血的疗效对比分析 [J]. 中华神经外科杂志 , 2024 , 40 ( 8 ): 804 - 809 . doi: 10.3760/cma.j.cn112050-20231211-00207 http://dx.doi.org/10.3760/cma.j.cn112050-20231211-00207 .
冯珂珂 , 尹绍雅 , 孙树鹏 , 等 . 立体定向穿刺抽吸术治疗高血压脑干出血手术体会 [J]. 中华急诊医学杂志 , 2020 , 29 ( 2 ): 272 - 274 . doi: 10.3760/cma.j.issn.1671-0282.2020.02.0031 http://dx.doi.org/10.3760/cma.j.issn.1671-0282.2020.02.0031 .
赵波 , 王嘉琛 , 聂文 , 等 . 软通道微创穿刺引流与内科保守治疗原发性脑干出血的临床疗效比较 [J]. 中国微侵袭神经外科杂志 , 2024 , 28 ( 2 ): 102 - 105 . doi: 10.11850/j.issn.1009-122X.2024.02.008 http://dx.doi.org/10.11850/j.issn.1009-122X.2024.02.008 .
耿一博 , 刘一齐 , 刘小莉 , 等 . 原发性脑干出血患者预后危险因素分析 [J]. 中华神经创伤外科电子杂志 , 2023 , 9 ( 2 ): 85 - 90 . doi: 10.3877/cma.j.issn.2095-9141.2023.02.004 http://dx.doi.org/10.3877/cma.j.issn.2095-9141.2023.02.004 .
热依汗 , 高英 , 王力 , 等 . 原发性脑干出血内科保守治疗的预后分析 [J]. 中国实用神经疾病杂志 , 2010 , 13 ( 18 ): 23 - 24 . doi: 10.3969/j.issn.1673-5110.2010.18.011 http://dx.doi.org/10.3969/j.issn.1673-5110.2010.18.011 .
刘凤强 , 王泽锋 , 俞晓波 , 等 . 立体定向精准抽吸治疗原发性脑干出血的疗效及其影响因素分析 [J]. 中华神经外科杂志 , 2019 , 35 ( 11 ): 1094 - 1098 . doi: 10.3760/cma.j.issn.1001-2346.2019.11.004 http://dx.doi.org/10.3760/cma.j.issn.1001-2346.2019.11.004 .
Huang K , Ji Z , Sun L , et al . Development and validation of a grading scale for primary pontine hemorrhage [J]. Stroke , 2017 , 48 ( 1 ): 63 - 69 . doi: 10.1161/STROKEAHA.116.015326 http://dx.doi.org/10.1161/STROKEAHA.116.015326 .
Roberts DW , Strohbehn JW , Hatch JF , et al . A frameless stereotaxic integration of computerized tomographic imaging and the operating microscope [J]. J Neurosurg , 1986 , 65 ( 4 ): 545 - 549 . doi: 10.3171/jns.1986.65.4.0545 http://dx.doi.org/10.3171/jns.1986.65.4.0545 .
吴卓晋 , 潘超 , 张萍 , 等 . 立体定向技术的研究进展 [J]. 神经损伤与功能重建 , 2020 , 15 ( 10 ): 585 - 587 . doi: 10.16780/j.cnki.sjssgncj.20201050 http://dx.doi.org/10.16780/j.cnki.sjssgncj.20201050 .
郭士琨 , 刘永生 . 立体定向幕下入路脑干穿刺引流治疗脑干出血老年患者的临床研究 [J]. 中华老年医学杂志 , 2023 , 42 ( 5 ): 557 - 562 . doi: 10.3760/cma.j.issn.0254-9026.2023.05.013 http://dx.doi.org/10.3760/cma.j.issn.0254-9026.2023.05.013 .
韩昊锦 , 牛光明 , 刘展 , 等 . 神经导航引导下无框架立体定向穿刺引流治疗脑干出血的临床疗效及治疗经验 [J]. 实用心脑肺血管病杂志 , 2021 , 29 ( 3 ): 85 - 90 . doi: 10.12114/j.issn.1008-5971. 2021.00.045 http://dx.doi.org/10.12114/j.issn.1008-5971.2021.00.045 .
Ponnusamy K , Mohr C , Curet MJ . Clinical outcomes with robotic surgery [J]. Curr Probl Surg , 2011 , 48 ( 9 ): 577 - 656 . doi: 10.1067/j.cpsurg.2011.05.002 http://dx.doi.org/10.1067/j.cpsurg.2011.05.002 .
田增民 , 刘宗惠 , 杜吉祥 , 等 . 新型机械臂在脑外科定向手术中的应用 [J]. 中华神经外科杂志 , 2000 , 16 ( 2 ): 110 - 112 . doi: 10.3760/j.issn:1001-2346.2000.02.014 http://dx.doi.org/10.3760/j.issn:1001-2346.2000.02.014 .
盛文国 , 龙连圣 , 谢虎 , 等 . 无框架立体定向下抽吸清除重度原发性脑干出血疗效初步分析 [J]. 临床神经外科杂志 , 2023 , 20 ( 3 ): 336 - 339 . doi: 10.3969/j.issn.1672-7770.2023.03.020 http://dx.doi.org/10.3969/j.issn.1672-7770.2023.03.020 .
Bao D , Ni S , Chang B , et al . Short-term outcomes of robot-assisted minimally invasive surgery for brainstem hemorrhage:a case-control study [J]. Heliyon , 2024 , 10 ( 4 ): e25912 . doi: 10.1016/j.heliyon. 2024.e25912 http://dx.doi.org/10.1016/j.heliyon.2024.e25912 .
刘云阳 , 王修玉 , 张丙杰 , 等 . 机器人辅助立体定向穿刺抽吸治疗脑干出血的疗效分析 [J]. 中华神经外科杂志 , 2023 , 39 ( 9 ): 899 - 902 . doi: 10.3760/cma.j.cn112050-20221211-00573 http://dx.doi.org/10.3760/cma.j.cn112050-20221211-00573 .
Ichimura S , Bertalanffy H , Nakaya M , et al . Surgical treatment for primary brainstem hemorrhage to improve postoperative functional outcomes [J]. World Neurosurg , 2018 , 120 : e1289 - e1294 . doi: 10. 1016/j.wneu.2018.09.055 http://dx.doi.org/10.1016/j.wneu.2018.09.055 .
Zhu H , Wang Z , Yu J , et al . Role and mechanisms of cytokines in the secondary brain injury after intracerebral hemorrhage [J]. Prog Neurobiol , 2019 , 178 : 101610 . doi: 10.1016/j.pneurobio.2019. 03.003 http://dx.doi.org/10.1016/j.pneurobio.2019.03.003 .
中华医学会神经外科学分会 , 中国医师协会急诊医师分会 , 中华医学会神经病学分会脑血管病学组 , 等 . 高血压性脑出血中国多学科诊治指南 [J]. 中国急救医学 , 2020 , 40 ( 8 ): 689 - 702 . doi: 10.3969/j.issn.1002-1949.2020.08.001 http://dx.doi.org/10.3969/j.issn.1002-1949.2020.08.001 .
Shrestha BK , Ma L , Lan ZG , et al . Surgical management of spontaneous hypertensive brainstem hemorrhage [J]. Interdiscip Neurosurg , 2015 , 2 ( 3 ): 145 - 148 . doi: 10.1016/j.inat.2015.06.005 http://dx.doi.org/10.1016/j.inat.2015.06.005 .
施辉 , 周辉 , 王富元 , 等 . 经膜髓帆入路手术治疗桥脑高血压相关性脑出血 [J]. 临床神经外科杂志 , 2017 , 14 ( 1 ): 49 - 51 . doi: 10.3969/j.issn.1672-7770.2017.01.013 http://dx.doi.org/10.3969/j.issn.1672-7770.2017.01.013 .
周全 , 谭源福 , 张超元 , 等 . 神经内镜联合显微镜手术治疗原发性高血压脑干出血的现状及发展前景 [J]. 微创医学 , 2024 , 19 ( 3 ): 291 - 295 . doi: 10.11864/j.issn.1673.2024.03.14 http://dx.doi.org/10.11864/j.issn.1673.2024.03.14 .
Huang C , Liu X , Zhao G , et al . Neuroendoscopic surgery for brainstem hemorrhage:technical notes and preliminary clinical results [J]. Clin Neurol Neurosurg , 2024 , 246 : 108576 . doi: 10.1016/j.clineuro.2024. 108576 http://dx.doi.org/10.1016/j.clineuro.2024.108576 .
梁建广 , 董军 , 屈鸣麒 , 等 . 神经内镜辅助手术治疗脑干出血破入第四脑室 [J]. 中华神经医学杂志 , 2013 , 12 ( 2 ): 197 - 199 . doi: 10.3760/cma.j.issn.1671-8925.2013.02.021 http://dx.doi.org/10.3760/cma.j.issn.1671-8925.2013.02.021 .
Liu B , Zheng T , Mao Y , et al . Endoscopic endonasal transclival approach to spontaneous hypertensive brainstem hemorrhage [J]. J Craniofac Surg , 2020 , 31 ( 5 ): e503 - e506 . doi: 10.1097/SCS.0000000000006599 http://dx.doi.org/10.1097/SCS.0000000000006599 .
路贵 , 杜宝顺 , 王阳 , 等 . 神经内镜辅助显微镜下治疗重型脑干出血的疗效分析 [J]. 国际神经病学神经外科学杂志 , 2020 , 47 ( 1 ): 10 - 13 . doi: 10.16636/j.cnki.jinn.2020.01.003 http://dx.doi.org/10.16636/j.cnki.jinn.2020.01.003 .
张圣坤 , 唐忠 , 陈启富 , 等 . 长程、长时间持续脑室外引流术治疗脑室出血伴脑积水的疗效 [J]. 中国临床神经外科杂志 , 2024 , 29 ( 4 ): 209 - 213 . doi: 10.13798/j.issn.1009-153X.2024.04.004 http://dx.doi.org/10.13798/j.issn.1009-153X.2024.04.004 .
陈国昌 , 石小峰 , 刘政委 , 等 . 实时颅内压监测下脑室外引流治疗脑干出血临床分析 [J]. 中国实用神经疾病杂志 , 2020 , 23 ( 7 ): 589 - 592 . doi: 10.12083/SYSJ.2020.07.103 http://dx.doi.org/10.12083/SYSJ.2020.07.103 .
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