高血压脑出血不同术式治疗疗效的回顾性研究

Therapeutic efficacies of different surgical methods for hypertensive intracerebral hemorrhage： A retrospective analysis

目的探讨高血压脑出血手术治疗方法及其适应证的选择和疗效。方法收集我院1998年1月-2003年7月采用定向引流、小骨窗开颅及骨瓣开颅三种术式治疗高血压脑出血158例，按照GCS评分和血肿量各分为3个亚组，并对各不同术式的手术适应症和疗效作一对比分析，最后得出结论。结果对高血压脑出血GCS评分较高（11～14分）、血肿量较小（20～50mL）的病人选用定向引流可降低致残率，中等量血肿（51～80mL）的病人采用小骨窗开颅能明显减少致残率，巨大血肿（〉80mL）的病人采用骨瓣开颅能明显降低死亡率。结论高血压脑出血手术治疗三种术式各有其优缺点，但小骨窗开颅具有手术创伤小，病人恢复快，并能及时有效地解除脑受压的特点，现不失为一种治疗高血压脑出血有效的治疗方法。

Objective To explore the therapeutic efficacies of different surgical methods for hypertensive intracerebral hemorrhage so as to find out their indications. Methods Admitted into our hospital fi：om January, 1998 to July, 2003, 158 cases of hypertensive intracerebral hemorrhage treated by stereotactic aspiration or craniotomy through small bone window or craniotomy through bone flap was divided into 3 subgroups according to GCS scores and hematoma volume. Indications and therapeutic outcomes of these 3 surgical methods were analyzed comparatively. Results The morbidity was low in the stereotactic aspiration group with GCS 11-14 and small hematoma volume （20-50 mL）. The patients＇ morbidity was reduced in small-bone-window craniotomy group with moderate hematoma volume （51-80 mL）. The mortality rate decreased obviously in the bone-flap craniotomy group with great hematoma volume （over 80 mL）. Condnsion The 3 surgical methods for hypertensive intracerebral hemorrhage have the advantages and disadvantages respectively, but the craniotomy through small bone window has the marked superiorities such as minimal invasion and quick rehabilitation and immediate decompression. Therefore, it is a effective method to treat hypertensive intracerebral hemorrhage.