高血压基底节脑出血合并脑疝的手术治疗

Surgical treatment of hypertensive hemorrhage in basal ganglia regions combined with cerebral hernia

目的探讨手术治疗高血压基底节脑出血脑疝治疗办法和临床疗效。方法43例高血压基底节区脑出血并脑疝患者,床旁采用YL-1型针穿刺抽吸部分血肿,缓解高颅压症状,尔后行标准大骨瓣开颅去骨瓣减压,微创皮层造瘘,显微镜下清除残余血肿。结果本组43例,无一例出现术后再出血,死亡6例,死亡率14%。术后随访3-12个月,根据ADL分级法判定疗效。Ⅰ级2例,Ⅱ级10例,Ⅲ级17例,Ⅳ级5例,Ⅴ级3例。结论YL-1型针穿刺引流术联合标准大骨瓣开颅去骨瓣减压,显微镜下清除血肿是高血压基底节区脑出血脑疝行之有效的办法。

Objective To explore the methods and clinical effect of surgical treatment on hypertensive hemorrhage in basal ganglia region with cerebral herniation. Methods 43 eases of hypertensive hemorrhage in basal ganglia region with cerebral herniation were given minimally invasive puncture drainage initially and then were underwent standard large craniotomy and removed the bone flap, cortex stoma is made by minimally invasive technique, intracranial hematomas were removed under microscope. Results Postoperative bleeding were not occurred in all eases, 6 patients died, fatality was 14%. Activities of daily living（ADL） evaluation at 3 - 12 months follow - up showed that 2 patients were ADL1 （ 12% ）, 10 patients were ADL2（ 30% ）, 17patients were ADL3 （40%）, 5 patients were ADIA （9%） 3 were ADL5 （3%）. Conclusion Minimally invasive puncture drainage initially and then underwent standard large hone flap craniotomy, decompression by removal of bone flap, cortex stoma is made by minimally invasive technique, intracranial hematomas removed under microscope are an effective treatment for hypertensive hemorrhage in basal ganglia region with cerebral herniation.