额后部入路锥颅血肿穿刺抽吸引流术治疗高血压基底节区脑出血临床研究

The clinical study on the hypertensive cerebral hemorrhage in the basal ganglion treated by haematoma fluidify drainage operation which though boring skull and placing tube with the entrance of rear forehead

目的探讨经额后部入路锥颅置管血肿抽吸液化引流术治疗高血压基底节脑出血与传统微创手术方法的疗效比较。方法经额后部入路锥颅置管血肿抽吸液化引流术治疗高血压基底节脑出血患者79例（观察组）,并与同期采用传统颞部入路微创手术治疗的75例患者（对照组）进行比较。各组出血量均为50--80m l,观察组采用额后部入路进行穿刺,同时使用有可调节钻入深度的限位器的钻头,钻穿颅骨,置入硅胶管抽吸部分血肿后,再引流。对照组采用传统颞部入路手术治疗,其余同上。于手术后7d、14d及30d分别进行神经功能评分、术后脑疝、再出血等并发症及死亡率等观察比较。结果治疗后7d两组之间比较神经功能评分（改良爱丁堡＋斯堪的那维亚评分标准）无显著性差异（P〉0.05）,而死亡率、脑疝发生率观察组明显低于对照组（P〈0.05）;14d及30d比较观察组神经功能评分均优于对照组,且30d两组总并发症（再出血、脑疝）及死亡率比较观察组明显低于对照组,且有统计学意义（P〈0.05）。结论经额后部入路锥颅置管血肿抽吸液化引流术作为一种全新微创手术方式,其疗效及安全性明显优于传统颞部微创手术方式。

Objective To study the effective of haematoma fluidify drainage operation which through boring skull and placing tube with the entrance of rear forehead compared with the traditional method of minimally invasive operation. Methods 79 cases of hypertensive cerebral hemorrhage in the basal ganglion treated by haematoma fluidify drainage operation through boring skull and placing tube with the entrance of rear forehead were included as observe group, and 75 eases patients treated by haematoma fluidify drainage operation through boring skull and placing tube with the entrance of temporal bone were as control group. The bleeding quantities were both 50 -80ml in each group,the observe group adopt the rear forehead route puncture,at the same time,we used the aiguille with restrict position implement that could adjust the depth, bore the skull,place silica gel tube and pump portion of haematoma, and then drainage. The control group take the same methods as observe group except adopt traditional route of temporal bone. We observed the neural-functional grade,hernia of brain, elapse cerebral hemorrhage, cerebral effusion and death rate after the operation for 7d, 14d and 30d. Results In the comparison of neural-functional grade after operation for 7d,there wasn＇t static significance between the two groups（ P 〉 0.05 ） ,but the death rate and hernia of brain rate were obviously lower in the observe group than the control group（ P 〈 0.05 ） , and there were static significances between the two groups in neural-functional grade after operation for 14 and 30 days （P 〉 0.05 ）. The total subsequent syndrome（ hernia of brain, relapse cerebral hemorrhage） and death rate in observe group were significantly lower than in control group after operation for 30 days （ P 〈 0.05 ）. Conclusion The haematoma fluidify drainage operation through boring skull and placing tube with the entrance of rear forehead is one of the fire-new mode minimally invasive operation, it＇s safety and effect are obviously higher than traditional minimally invasive operation.