高血压脑出血不同血肿形态的病理观察

Observation of different pathomorphology of hematomas in patients with hypertensive intracerebral hemorrhage

目的探讨高血压脑出血的不同血肿形态的病理变化和病因。方法回顾性分析2006年1月至2007年11月收治的73例基底节区脑出血病人的临床资料。根据血肿形态将其分为稳定型脑出血和不稳定型出血,均符合手术指征并采取小骨窗开颅清除血肿,术中取血凝块送病理检查。结果手术中见稳定型脑出血血凝块易于清除,与周围脑组织无明显粘连;不稳定型脑出血的血凝块与周围脑组织粘连较紧密,不易清除,并可见条索状结构伸入周围脑组织且出血较多,呈喷射状,系动脉出血。结论不稳定型脑出血患者基底节区的血管较稳定型脑出血患者的血管丰富,此为不稳定型脑出血患者血肿扩大的主要原因。对不稳定型脑出血患者应严密观察其病情变化,警惕其血肿扩大,以便及时为患者选择适当的治疗方法,降低死亡率、致残率。

Objective To discuss change in the pathomorphology of the hematomas and its etiology in the patients with hypertensive intracerebral hemorrhage. Methods The clinical data of 73 patients with hypertensive cerebral basilar region hemorrhage who were treated from January, 2006 to November, 2007 were analyzed retrospectively. They were divided into both the groups, i.e. stable hemorrhage and unstable hemorrhage groups according to hematoma morphology. All the patients underwent the neurosurgery through the small bone window craniotomy for hematoma evacuation. The blood clot was histopathologieally examined. Results The hematomas were easiFy evacuated and did not adhere to the brain tissues around them in the stable hemorrhage group. The hematomas closely adhered to the brain tissues 0round them and was difficultly removed, cord-like structure was seen in the cerebral tissues around the hematomas, and there was massive hemorrhage which was like a spray and from the arteries in the unstable hemorrhage group. Conclusions The blood vessels in the basilar regions are richer in the patients with unstable hemorrhage than those in the patients with stable hemorrhage. The richer vessels in the basilar regions may be the main cause of hematoma enlargement in the patients with unstable hemorrhage. The patients with unstable hemorrhage should be closely observed in order to take the corresponding treatment measures and to decrease the morbidity and mortality.