基底节区高血压脑出血手术治疗术式选择

Effect of different operative incisions for treatment of hypertensive intracerebral hemorrhage

目的总结选择不同的手术方式外科治疗基底节区高血压脑出血的临床经验。方法回顾142例基底节区高血压脑出血手术治疗病例,根据病情严重程度、出血部位、出血量选择不同的手术术式,传统开颅46例,选择额颞大骨瓣颞中回入路;选择直切口小骨窗微创开颅96例,一般根据头颅CT定位血肿量最大径处的皮层入路。结果本组有36例小骨窗微创开颅患者术后因再出血、或难以度过脑水肿期,而出现病情加重。选择额颞大骨瓣的患者中,术后仅有5例因为再出血、或难以度过脑水肿期,出现病情恶化(P<0.05)。结论应根据病情的严重程度、血肿部位、血肿量、脑组织受损范围等选择相应的手术方式。

Objective To summarize the clinical experiences of different operative model in surgical treatment for hypertensive intracerebral hemorrhage （HICH）. Methods The clinical data of 142 cases of HICH received surgical treatment were reviewed. According to the severity of illness, hemorrhage volume and location different operative incisions were ehoosed. 46 patients were treated by traditional large cranial window craniotomy, and 96 patients by small bone flap craniotomy. Commonly ,the approach and the size of eraniotomy were desigened according to the shape and location of hematoma demstrated by CT. Results In the small bone flap craniotomy group,36 cases took place rebleeding, uncontrolled brain edema and aggravated neurological deficit after operation, however, 5 cases had the complications in the traditional large cranial window group. The result between two groups had significant difference（P 〈 0.05 ）. Conclusions Compared with the small bone flap craniotomy, the traditional large cranial window craniotony had less complications and more advantages.