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目的 探讨立体定向穿刺引流术治疗原发性脑干出血的疗效及预后影响因素。方法 回顾性分析2015年1月至2024年6月郑州市中心医院收治的95例原发性脑干出血患者的临床资料，其中采用立体定向穿刺引流术治疗55例（手术组），保守治疗40例（保守组）。出院后随访6个月，采用GOS评分评估预后。由于脑干出血的特殊性，设定GOS评分1～2分为预后不良，3～5分为预后良好。结果 出院后6个月：保守组GOS评分1分18例，2分20例，3分1例，4分1例，预后良好2例；手术组GOS评分1分5例，2分28例，3分20例，4分2例，预后良好22例。与保守组相比，手术组病死率明显降低（9.1%vs. 45.0%,P<0.001），而预后良好率明显增高（40.0%vs. 5.0%,P<0.001）。多因素logistic回归分析显示，术前GCS评分越高，手术预后越好；血肿偏向一侧患者的手术预后较好。结论 立体定向穿刺引流术清除脑干血肿是一种有效的微创方法，在降低患者病死率和改善神经功能方面展现出积极作用。偏侧出血及术前GCS评分较高的患者手术治疗预后较好。
Abstract：Objective To investigate the efficacy of stereotactic puncture and drainage for primary brainstem hemorrhage and the factors influencing prognosis. Methods The clinical data of 95 patients with primary brainstem hemorrhage admitted to Zhengzhou Central Hospital from January 2015 to June 2024 were retrospectively analyzed. Among them, 55 patients were treated with stereotactic puncture and drainage(surgical group), and 40 patients received conservative treatment(conservative group). Patients were followed up for 6 months after discharge, and prognosis was assessed using the GOS score. Considering the particularity of brainstem hemorrhage, a GOS score of 1～2 was defined as a poor prognosis, and 3～5 as a favorable prognosis. Results At the 6-month follow-up after discharge, the conservative group had 18 cases with GOS 1, 20 with GOS 2, 1 with GOS 3, 1 with GOS 4, resulting in 2 cases with favorable prognosis. The surgical group had 5 cases with GOS 1, 28 with GOS 2, 20 with GOS 3, 2 with GOS 4, resulting in 22 cases with favorable prognosis. Compared with the conservative group, the surgical group showed a significantly lower mortality rate(9.1% vs. 45.0%, P<0.001) and a significantly higher rate of favorable prognosis(40.0% vs. 5.0%, P<0.001). Multivariate logistic regression analysis indicated that a higher preoperative GCS score was associated with a better surgical prognosis, and patients with laterally-oriented hematomas also had a better surgical outcome. Conclusion Stereotactic puncture and drainage for evacuation of brainstem hematoma is an effective minimally invasive method, demonstrating positive effects in reducing patient mortality and improving neurological function. Patients with laterally-oriented hemorrhages and those with higher preoperative GCS scores tend to have a better prognosis after surgical treatment.
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基本信息:
DOI：10.13798/j.issn.1009-153X.2026.01.002
中图分类号:R651.12
引用信息:
[1]梁阿铭,韩义娜,董瑞,等.立体定向穿刺引流术治疗原发性脑干出血的疗效[J].中国临床神经外科杂志,2026,31(01):7-10.DOI:10.13798/j.issn.1009-153X.2026.01.002.
基金信息:
河南省医学科技攻关项目（242102310144）
2026-01-25
2026-01-25