患者67岁男性,主因:被人发现意识不清2小时入院
入院查体:BP:172/78mmHg,昏迷,刺激不睁眼,保留口咽通气道,刺激稍屈,GCS:4分。双侧瞳孔各1.5mm,对光反射迟钝
![](https://res.medtion.com/uploads/mp/20190615/20190615/26fffd8358844d98947de94d783a2428_710.jpg)
头CT显示:脑室出血,脑室铸形,出血点在右侧侧脑室三角区,血肿量较大。
![](https://res.medtion.com/uploads/mp/20190615/20190615/261065684aa04662b92e042592986867_710.jpg)
手术切口
![](https://res.medtion.com/uploads/mp/20190615/20190615/7355f858d6b64b44a868bbb616470cc6_710.jpg)
![](https://res.medtion.com/uploads/mp/20190615/20190615/12c0a69641424c97bf287b368f718953_710.jpg)
![](https://res.medtion.com/uploads/mp/20190615/20190615/0bdb94268e1847cd953a1df10f5300bc_710.jpg)
![](https://res.medtion.com/uploads/mp/20190615/20190615/d1c28a84ef0e4194b1124606e77f6502_710.jpg)
![](https://res.medtion.com/uploads/mp/20190615/20190615/b343d9fd8d184a3b95b29d877b8ec89d_710.jpg)
血肿清除后于左侧行EVD
![](https://res.medtion.com/uploads/mp/20190615/20190615/fd4240e78e4a47439de2f7ff0d101d5d_710.jpg)
术后三天CT显示:三角区及颞角血肿清除干净,每日应用尿激酶冲洗,左侧冲洗,右侧引流,保持通畅。
![](https://res.medtion.com/uploads/mp/20190615/20190615/6048e3a5ecb943e09467624e0124a77e.jpg)
术后第六天复查头CT:侧脑室血肿基本引流干净。
体会:类似侧脑室三角区出血,额角入路观察出血点视角受限。侧方入路清除侧脑室双侧体部血肿视角受限。内镜联合EVD也是快速清除血肿的方法。