锥颅引流、小骨窗开颅、大骨瓣开颅治疗高血压脑出血的临床研究

Skull drainage, a small bone window cralnotomy and large trauma craniotomy in the treatment of hypertensive cerebral hemorrhage： A comparative analysis

目的：探讨小骨窗手术及锥颅引流治疗高血压脑出血（HCH）疗效和预后,与传统大骨瓣开颅进行比较分析.方法：分析我院神经外科2003年6年6月-2009年6月收治320例HCH病人,其中120例行传统大骨瓣开颅手术,行锥颅引流术治疗100例,行小骨窗开颅血肿清除术治疗100例,观察3组病人死亡率及远期疗效.结果：锥颅引流、小骨窗开颅病人的死亡率与大骨瓣开颅手术组无统计学差异（P〉0.05）.按照Glasgow Outcome Scale（GOS）评分对患者进行预后评估,小骨窗开颅组V级23例,Ⅳ级24例,愈后良好率57.3%.锥颅引流组V级19例,Ⅳ级27例,愈后良好率58.9%.大骨瓣开颅组V级8例,Ⅳ级21例,愈后良好率30.2%.其中小骨窗开颅组和锥颅引流组的愈后良好率均优于大骨瓣开颅组且有统计学差异（P〈0.05）,而小骨窗开颅组和锥颅引流组的愈后良好率之间无统计学差异（P〉0.05）.结论：锥颅引流、小骨窗开颅与大骨瓣开颅治疗HCH相比虽不能提高患者生存率,但前两组患者的愈后良好率较高.

Objective： To explore the effort and prognosis of minimally invasive Surgery（MIS） in the treatment of hypertensive cerebral hemorrhage（HCH）, and make comparative analysis with traditional large trauma craniotomy. Methods： A total of 320 patients with HCH were recruited to take part in this study, all of them were from the neurosurgery department of our hospital, admitted from June 6, 2003 to June, 2009, and 120 of which were treated with large trauma eraniotomy, 100 for skull drainage, and the left for a small bone window eraniotomy. All the groups＇ mortality and long-term efforts were studied. Results： No difference was found in mortality between the Skull drainage, a small bone window crainotomy and large trauma craniotomy group（p〉0.05）. To evaluate the patients＇ prognosis with the Glasgow Outcome Seale（GOS）, the a small bone window eraniotomy group had 23 patients for V class, 24 for Ⅳ class, and the rate of good prognosis was 57. 3%. The large trauma craniotomy group had 8 for V class, 21 for Ⅳ, and the rate was 30. 1%. And there were 19 Vs and 27 IVs for skull drainage group, the good prognosis rate was 58.9%. The good prognosis rate of a small bone window eraniotomy group and skull drainage group is significantly higher than that of large trauma crainiotomy group（p 〈0.05）, but no difference was found between a small bone window eraniotomy group and skull drainage group（p〉0. 05）. Conclusion： Based on the HCH patients＇ clinical condition and CT informations, choose the best surgery pattern for patients.