利用弥散张量成像评估中小量基底节区高血压脑出血微创手术的治疗.doc

利用弥散张量成像评估中小量基底节区高血压脑出血微创手术的治疗效果 蒋永祥, 马 颖，程 远，陈维福 (重庆医科大学附属第二医院神经外科，重庆400010)±7.242ml)。所有患者在发病后48 h内和发病后14 d进行DTI扫描，得到双侧皮质脊髓束(corticospinal tract, CST)的各向异性分数(fractional anisotropy, FA)及弥散张量纤维束成像(diffusion tensor tractography, DTT)图像，并根据CST完整性将微创手术组分为A(1-2级，22例)、B(3级，30例)两个亚组，比较微创手术组和内科治疗组之间及A、B亚组之间在以上指标的差异。 结果 发病后首次DTI扫描显示微创手术组、内科治疗组受累侧的内囊区和大脑脚FA值均降低，两组间无明显差异(P＞0.05)，第2次DTI扫描提示微创手术组的FA值(内囊区，0.49±0.02；大脑脚，0.47±0.03)较内科治疗组(内囊区，0.39±0.02；大脑脚，0.43±0.03)明显升高(P＜0.05)且从DTT图像上可见微创手术组的CST恢复程度明显好于内科治疗组，提示对于这类患者微创手术治疗效果优于内科治疗。微创手术组的A亚组术后FA值(0.51±0.02)高于B亚组(0.48±0.02) (P＜0.05)，提示CST损伤越小，手术效果越好。结论 微创治疗可以提高中小量基底节区高血压脑出血患者预后，尤其是DTT显示CST以推移、变形为主者(1-2级)应更为积极的采取微创治疗。 [关键词] 高血压脑出血；基底节区；微创治疗技术；弥散张量成像；各向异性 Evaluate effects of minimally invasive techniques for evacuation of small to medium hematoma in patients with hypertensive intracerebral hemorrhage in basal ganglia: observed by diffusion tensor imaging Jiang Yong-Xiang, Ma Ying, Cheng Yuan▲,Chen Wei-Fu (Department of Neurosurgery, the Second Affiliated Hospital of Chong Qing Medical University, Chongqing 400010,China) Abstract: Objective To evaluate the effect of minimally invasive evacuation of small to medium hypertensive intracerebral hemorrhage (ICH) in basal ganglia by diffusion tensor imaging (DTI). Methods 101 patients with small to medium hypertensive ICH in basal ganglia were selected and divided into a minimally invasive treatment group (52 patients) and a medical treatment group (49 patients): the volume of hematoma was 15-36ml (the average volume was 23.36±7.242ml). All patients proformed DTI scan within 48 hours and 14 days after onset, the fractional anisotropy (FA) and the diffusion tensor tractography (DTT) of corticospinal tract (CST) in the affected and unaffected side were obtained. The minimally invasive treatment group was divided into A sub-group (1-2 grade, 22 patients) and B sub-group (3 grade, 30 patients) according to the integrity of CST. The data were compared between minimally invasive treatment grou