高血压脑出血不同术式治疗的回顾性研究

A retrospective analysis on therapeutic efficacy of different surgical methods for hypertensive intracerebral hemorrhage.

目的探讨高血压脑出血不同术式的适应症及疗效。方法回顾性分析手术治疗高血压脑出血392例，C在≤6、6～12、12～24h3个时段对骨瓣开颅、小骨窗开颅、微创碎吸3种术式手术治疗的结果进行对比分析，术后随访6-12个月。结果中等量出血，时间≤6h3种术式疗效接近；而6h后手术开颅及小骨窗术式有明显优势（P＜0．05）；大量出血开颅手术最具优势（≤6h，组P＜0．01；6～12h组P＜0．05），而小骨窗亦优于微创手术（P＜0．05）。结论中等量以上脑出血，提倡早期外科干预，短期疗效随访提示：开颅手术血肿清除术优于微创血肿碎吸术。

Objective To explore the therapeutic efficacy of different surgical methods for hypertensive intracerebral hemorrhage （ HICH ）, find out their indications. Methods To analyze the therapeutic effects of different surgical methods at different operating time. There were comparison of therapeutic efficacy of three surgical methods, craniotomy through bone flap, small-bone-window craniotomy and stereotactic aspirations,at 3 different operative intervals, ≤h,6- 12h and 12 - 24h after HICH.The patients were followed-up for 6- 12m. Results For moderate hemorrhage cases there was no significant difference among different operative meathods, whitin 6h after HICH. Craniotomy proved to be more advantageous（ P 〈 0.05 ）after 6h. For serious hemorrhage cases bone-flap craniotomy is the most effective approach（ P 〈 0.01 at ≤6h interval after HICH, P 〈 0.05 at 6 - 12h interval after HICH）. And small-bone-window is better than stereotactic aspiration. Conclusion Earlier surgical intervention is promoted for moderate and serious HICH. On the findings of short term follow-up, craniotomy evacuation of HICH proved to be more effective than stereotactic aspiration for moderate and serious HICH.