微骨窗经额中回入路手术治疗高血压脑出血脑室铸型

Treatment of hypertensive ventrieular hemorrhage cast through midfrontal keyhole approach

目的初步探讨微骨窗经额中回入路显微镜下手术治疗高血压脑出血脑室铸型的可行性及优势。方法30例侧脑室内铸型血肿患者按照随机数字表法分为2组（各15例）：单纯侧脑室外引流术组（A组），微骨窗经额中回入路显微镜下血肿清除术组（B组）。术后随访3～6月，按格拉斯哥预后评分（60s）对比评价2种术式的疗效。结果A组死亡6例，植物生存或严重残疾6例，中等残疾或恢复良好3例；B组分别为1例、2例、12例。B组患者预后明显优于A组，差异有统计学意义（P〈0．05）。结论微骨窗经额中回入路显微镜下血肿清除术治疗高血压脑出血脑室铸型疗效较好．优于单纯侧脑室外引流术。

Objective To evaluate the feasibility and advantages ofmidfrontal keyhole approach for treatment of hypertensive ventricular hemorrhage cast. Methods Thirty patients with hypertensive ventricular hemorrhage cast were randomized into 2 groups to receive ventricular drainage （group A） or microsurgical hematoma elimination through midfrontal keyhole approach （group B）. The clinical outcomes of the patients were assessed according to the Glasgow Outcome Scale （GOS） after 3-6 months of follow-up. Results In group A, 6 patients had GOS grade 1, 6 had grade 2-3, and 3 had grade 4-5 outcomes. In group B, 1 patient had GOS grade 1, 2 had grade 2-3, and 12 had grade 4-5 outcomes. The patients in group B had significantly better outcomes than those in group A. Conclusion Microsurgical hematoma elimination through the midfi＇ontal keyhole approach produces better therapeutic effect than ventricular drainage in the treatment of hypertensive ventricular hemorrhage cast.