Using the Nasopharyngeal Airway as a Transparent Sheath for Endoscopic Evacuation of Hematoma Induced by Hemorrhagic Stroke

使用內視鏡來進行微創手術一直是現代神經外科發展的重點目標之一，針對出血性腦中風，已有許多神經外科醫師運用內視鏡來移除這些血塊；然而這當中仍然存在許多困難點，其中之一就是缺乏合適的管子做為搭配內視鏡手術時的穿透管道；現有的管材若是具有透光性質的都相當昂貴，而性質相近的鼻咽呼吸管卻很便宜並且在大多數的醫院內都容易取得。從2005年開始，我們嘗試使用內視鏡針對出血性腦中風來進行腦中血塊的移除，所需要的手術器械包含了0度硬式內視鏡，管子前端具有單極電燒功能的絕緣型抽吸管，並搭配鼻咽呼吸管來作為上述器械操作時的穿透通道。截至目前為止總共嘗試完成12例手術，所有病例皆成功達成移除80%以上血塊體積的手術目標，而且在術後的3個月內追蹤沒有發現任何死亡病例。這樣初步的成果顯示使用鼻咽呼吸管來作為內視鏡下移除出血性腦中風血塊的穿透通道是安全而且有效的。

關鍵字

神經內視鏡；手術技巧；出血性腦中風；鼻咽呼吸管

並列摘要

Background and Purpose: Minimally invasive endoscopic removal of hematoma induced by hemorrhagic stroke is a modern technique in neurosurgery. However, this surgical technique is still believed to be difficult due to lack of a proper transparent material served as a working channel. A transparent sheath designed for intracranial endoscopic surgery is an important assistant equipment. However, the cost of the sheath is too expensive to be used in ordinary brain surgery. Therefore, here we adjust the nasopharyngeal airway, which is less expensive, to be the transparent sheath. Methods: Since 2005, we had tried to perform endoscopic evacuation for the hematoma induced by hemorrhagic stroke. The nasopharyngeal airway was used as the transparent sheath in each case. Under the help of one rigid straight 0-degree endoscope, the hematoma was removed by the sucker piece by piece. If any bleeding happened, it could be controlled by monopolar coagulator which is located on the tip of sucker. Results: There were 7 male and 5 female patients who accepted this procedure. The mean age was 56.1 years (range 38 to 78 years). Up to eighty percent of hematoma was successfully evacuated by this endoscopic surgery in all patients. We used Glasgow outcome scale to evaluate postoperative outcome. Nine patients (75%) returned to clear conscious state. No mortality was found during our follow-up for at least 3 months. But the long-term results should be closely observed. Conclusion: These preliminary results revealed that the nasopharyngeal airway is an effective and safe transparent sheath for endoscopic evacuation of intracerebral hematomas. Because of its less expensive and easily available character, the nasopharyngeal airway has the great potential benefit to become the useful transparent sheath in neuroendoscopic surgery.

並列關鍵字

Neuroendoscopy ； Techniques ； Cerebral hemorrhage ； Nasopharyngeal airway

國際替代計量

Using the Nasopharyngeal Airway as a Transparent Sheath for Endoscopic Evacuation of Hematoma Induced by Hemorrhagic Stroke

全文下載

主題瀏覽