神经内镜辅助小骨窗开颅术治疗高血压脑出血56例疗效分析

Endoscope-assisted small bone window craniotomy for hypertensive cerebral hemorrhage:clinical analysis of 56 cases

目的:探讨神经内镜辅助小骨窗开颅手术治疗高血压脑出血的效果。方法:56例高血压脑出血患者均在全麻下行神经内镜辅助小骨窗开颅术。结果:32例血肿基本清除,20例血肿残留量小于10%,无一例再出血,10例单侧瞳孔散大者均回缩。4例出院后死亡,存活52例。根据ADL(日常生活能力)分级:1级10例、2级22例、3级10例、4级8例、5级2例。结论:该术式损伤小,进入病灶时间短,血肿清除及止血彻底。但操作空间狭小,对设备及手术医师显微技术要求高,且对血肿量较大的患者无"外减压"效果,不利于在基层推广使用。

Objective ： To investigate the effects of endoscope-assisted small bone window craniotomy on hypertensive cerebral hemorrhage. Methods： Endoscope-assisted small bone window craniotomy was performed on 56 patients with hypertensive cerebral hemorrhage under general anesthesia. Results： Complete hematoma clearance were observed in 32 cases, less than 10% residual hematoma volume in 20 cases, no re-bleeding occurred. 10 cases of unilateral mydriasis regained normal size. 4 patients died after discharge, and 52 survived. According to Activity of Daily Living Scale （ADL） , 10 cases were evaluated as grade 1, 22 cases grade 2, 10 cases grade 3, 8 cases grade 4, and 2 cases level 5. Conclusion： With advantages of smaller lesion, quicker access of focus, complete clearance of hematoma and hemostasia, and disadvantages of small operating space, high requirements for micro-surgeon equipments and operative technique, no decompression effects on patients with large amount of hematoma, endoscope-assisted small bone window craniotomy is not good for application in primary hospitals.