小骨窗微创手术治疗高血压基底节区脑出血的随访研究

A follow-up study of hypertensive basal ganglia encephalorrhagia treated with minimally invasive surgery

①目的比较小骨窗微创手术和常规骨瓣开颅手术治疗高血压性基底节脑出血的近期与远期疗效。②方法对符合入选标准的363例患者,依据手术方式不同分为小骨窗微创手术治疗组(186例)和常规骨瓣开颅手术组(177例)。比较两组患者术前颅内血肿量、发病至手术时间,GCS与ESS评分。术后神经功能恢复状况采用ESS评分和BI评价。③结果术前两组年龄、性别、颅内血肿量、发病至手术时间、GCS与ESS评分差异无统计学意义(P>0.05)。手术后ESS分数迅速增加,术后12个月小骨窗微创手术组ESS为(83.67±16.90)分,明显高于常规骨瓣开颅手术组ESS(69.50±20.88)分,两组比较差异具有统计学意义(P<0.01)。小骨窗微创手术组的恢复优良率也显著优于常规骨瓣开颅手术组(P<0.05)。④结论小骨窗微创手术具有手术创伤小、术后恢复快、远期效果好特点,是治疗高血压性基底节区出血的一种较为理想的手术方式。

Objective To compare the short and long therapeutic effects of the small bone flap craniomy （ also named minireally invasive surgery） and the normal bone flap craniomy on treating hypertension basal ganglia encephalorrhagia, Methods According to the types of operation procedures, 363 patients corresponding with the iaclusion criteria were -classified into the atinimally invasive surgery group （ 186 cases） and the normal bone flap craniomy group （ 177 cases）. Preoperative base information including age, gender construction, volume of intracranial hematoma, the time from the onset to the performance, Glasgow Coma Scale （GCS） Scores and European Stroke Scale （ESS） scores were compared between tbe two groups. On the other hand, postoperative brain functional recovery was measured and investigated with ESS and Barthel Index （BI）. Results There were not siguificant difference in the preoperative base information （ age, gender construction, volume of intracranial henmtoma, time from the onset to the performance, GCS score, and ESS scores） betwcen the two groups（ P 〉0.05）. Postoperative ESS scores increased rapidly. One year later, ESS score in the minimally invasive surgery group （83.67 ± 16.90） was significant higher than that in the normal bone flap craniomy group（69, 50 ±20.88 ） ,and there was significant difference between two groups（ P 〈 0.01 ）, Similarly, the recovery rate in the minimally invasive surgery group clearly was better titan that in the normal bone flap craniomy group（ P 〈0, 05 ）. Conclusion The minimally invasive surgery had the advantages of less brain damage, speedy postoperative recovery and better long- term therapeutic effects, therefore it was an ideal operation in treating hypertension basal ganglia encephalorrhagia.