两种手术方式治疗高血压基底节脑出血的疗效比较

Comparison of the effects of two different surgical treatments for hypertensive cerebral hemorrhage in the area of basal ganglion

目的比较小骨窗显微镜下手术及CT引导穿刺微创碎吸术治疗高血压基底节区出血的疗效。方法将高血压脑出血患者按治疗方法分成小骨窗开颅术组和CT引导穿刺微创碎吸组,其中小骨窗开颅术组38例,CT引导穿刺微创碎吸组36例。治疗期间记录意识障碍恢复时间,并随访1个月,进行神经功能缺损程度评分。结果小骨窗开颅术组意识障碍恢复时间1-6 d,神经功能缺损评分由（41.08±1.36）分改善为（8.56±1.21）分;CT引导穿刺微创碎吸组意识障碍恢复时间6-16 d,神经功能缺损评分由（41.36±1.25）分改善为（26.36±1.42）分。两组比较,意识障碍恢复时间及神经功能缺损程度评分差异有统计学意义（P〈0.01）,血肿清除量小骨窗组优于CT引导穿刺微创碎吸组（P〈0.01）。结论小骨窗显微镜下手术清除血肿充分、止血彻底,疗效优于CT引导穿刺微创碎吸术。

Objective To compare the effect of microsurgical treatment through a small skull window with that of computed tomographic-guided microtraumatic nyxis for hypertensive cerebral hemorrhage in the area of basal ganglion.Methods Cerebral hemorhage patients caused by hypertension were divided into small bone flap craniotomy group（38 cases） and computed tomographic-guided microtraumatic nyxis group（36 cases）.The time of consciousness restoration was recorded during the treatment and the assessment of neural function deficit was carried out after 1 month follow-up.Results In small bone flap craniotomy group,the time of consciousness restoration was 1-6 days,as compared with 6-16 days in computed tomographic-guided microtraumatic nyxis group,value of neural function deficits assessment improved from 41.08±1.36 to 8.56±1.21,compared with 41.36 ±1.25 to 26.36 ±1.42 in computed tomographic-guided microtraumatic nyxis group（P〈0.01）.The rehemorrhage rate of the patients with microsurgical treatment through a small skull window was higher than that of the patients with computed tomographic-guided aspiration（P〈0.01）.Conclusion The effect of microsurgery through a small skull window is more satis-factory than that of computed tomographic-guided microtraumatic nyxis.Hematoma could be enough evacuated and exact hemostasis could be achieved with microsurgery through a small skull window.