无显著占位效应高血压脑出血外科治疗的初步探讨

Preliminary explore management of hypertensive cerebral hemorrhage without remarkable occupied effect

目的针对高血压脑出血小型血肿,为尽量减轻血肿对脑组织产生的不良影响,提高病人生存质量,探讨安全、微创、简便、有效的手术方法.方法采用以MRI的TW1成像作为导航资料,神经导航系统实时监控下,血肿穿刺抽吸术的方法对8例血肿量在18～25mL的高血压脑出血患者,在血肿形成早期进行手术治疗.结果6例患者在术后第1天肢体肌力进步一级以上,出血后1个月和6个月时作日常生活能力(activity of daily living,ADL)评级,大部分患者获得恢复良好(Ⅰ～Ⅲ级).结论神经导航系统实时监控下血肿穿刺抽吸术,适用于高血压脑出血小型血肿的外科治疗,但其临床效果是否优于保守治疗有待进一步研究.

[Objective] To explore the appropriate, safe, microtraumatic, effective and convenient treatment for hypertensive cerebral hemorrhage with small hematoma and to improve the patient's life quality. [Method] According to the supervision with navigation system, 8 patients suffered from hypertensive cerebral hematoma with volume for 18 to 25 mL were treated by puncture-aspiration. The clinical status and prognosis of all the patients were discussed. [Result] 6 patients improved dynamic of contralateral limb for more than 1 grade a day after operation. Most patients recovered after one month and 6 months according to the scale for activity of daily living. [Conclusion] Puncture- aspiration of the hematoma under the supervision with navigation system is a probably reliable management for hypertensive cerebral hemorrhage with small hematoma. But its clinical advantages compared to the conservative therapy need to be evaluated.