额颞开颅治疗重症高血压脑出血69例临床分析研究

An investigation on 69 cases of hypertensive cerebral hemorrhage patients after fronto-temporal craniotomy and microneurosurgery through transsylvian approach

目的总结额颞开颅经外侧裂入路治疗高血压脑出血的手术经验。方法回顾我院于2006年1月至2008年6月收治的基底节区为主的高血压脑出血患者69例,均采用额颞开颅经外侧裂、岛叶入路,在显微镜下清除血肿。其中对瞳孔散大、脑疝形成患者行去骨瓣减压术45例,余24例行血肿清除骨瓣还纳术。结果全部血肿清除满意,术后除1例出血量大,术后12h死亡外,其余患者脑疝解除,当日清醒8例,意识朦胧13例,浅昏迷34例,深昏迷13例。手术后1个月功能恢复至Ⅰ～Ⅱ级19例,Ⅲ～Ⅳ级37例,Ⅴ级7例,死亡5例(7.4%)。结论本手术方法能充分利用脑组织正常间隙及非重要功能区进行操作,手术路径较短,脑组织损伤小,减少了手术的创伤;手术显微镜下能清晰看清出血点,准确有效地止血,降低了手术后再出血的风险,不受血肿量大小的限制,彻底清除。能够降低重症高血压脑出血患者病死率,提高存活者生存质量。

Objective To summarize operative expierence of fronto-temporal craniotomy and microneurosurgery through transsylvian approach for hypertensive cerebral hemorrhage.Methods We reviewed 69 cases of hypertensive cerebral hemorrhage patients from January,2006 to June,2008 in our hospital.They all received opertration of fronto-temporal craniotomy and microneurosurgery through transsylvian approach and had haematoma removed.Among them,we applied decompressive craniectomy surgery on 45 patients with mydriasis after herniation of brain,and the left 24 cases had haematoma removed and received cranial flap fixation.Results All haematoma were removed well,except for one patient died of serious hemorrhage 12 hours later,other patients＇ herniation of brain were cured.8 cases got consciousness in 24 hours,13 cases got twilight;13 cases got light coma;13 cases got deep coma.A month later,the function recovered well.Among them,19 cases got grade Ⅰ～Ⅱ;37 cases got grade Ⅲ～Ⅳ;7 cases got grade Ⅴ;5 patients died（7.4%）.Conclusion This operation approach allow doctors to operate in unimportant domain and interspace of brain tissue,and operation pathway is short.It lead less cerebral tissue damage.With operation microscope we can outguess bleeding spot and get exact haemostasis,so it lower the risk of rehaemorrhagia after operation.We needn＇t pay much attention to the hematoma size and remove it totally.It can lower the death rate of serious hypertensive cerebral hemorrhage patients,and improve living quality of survivors.