自发性脑出血并脑室铸型显微外科手术治疗的系列研究

The serial studies about microsurgical treatment of spontaneous intracerebral hemorrhage with intraventricular hematoma

目的探讨早期采用大骨瓣开颅显微神经外科手术治疗自发性脑出血并脑室铸型的可行性、方法及疗效。方法将本组病例按出血并铸型脑室的多少而分为四型,针对不同的分型设计并采用相应的术式,早期或超早期大骨瓣开颅,镜下一次性清除全部或大部分脑内及脑室内血肿铸型,置管引流,扩大硬膜成型缝合,弃骨瓣减压。结果本组198例,治愈165例,死亡33例,存活率为83.33%,死亡率为16.67%。治愈者出院时生存质量按日常生活能力(ADL)分级评定,Ⅰ级6例,Ⅱ级77例,Ⅲ级67例,Ⅳ级15例。结论该方法治疗自发性脑出血并脑室铸型对降低死亡率及提高生存率和生存质量有实际意义。

Objective To explore the safety and effectiveness of the microsurgical treament of spontaneous intracerebral hemorrhage with intrventricular hematoma. Methods According to the intrventricualr which effected by the hemorrhage,we decided their type（Ⅰ , Ⅱ , Ⅲ , Ⅳ）and adopted corrseponding approach,early or ultra-early open craniotomy to evacuate total/subtotal hemorrhage under microscope, A catheter wsa placed the cavity or the intraventricular to drainage, reconstrueted subdural space by amplifier sewing dura,abandoning bone flap to decompress. Results One hundred of ninety-eight patients were tredated microsurgically via craniotomy,one hundred of sixty-five patients had been cured; thirty-three patients had died; survival ratio was 83.33%; mortality was 16. 67%. acoording to the ADL outcome score, six patients were Grade Ⅰ ; seventy-seven were Grade Ⅱ; sixty-seven were Grade Ⅲ ; fifteen were Grade Ⅳ Conclusion The microsurgery is significant way to treat spontaneous intracerebral hemorrhage with intrventricular hematoma, which can decrease mortality and increase survival ratio;at the same time,which can improve survival quality.