小骨窗开颅显微手术治疗基底节高血压脑出血

Microsurgery for Hypertensive Basal Ganglia Hemorrhage by Small Skull-window Craniotomy

目的探讨小骨窗开颅微创治疗基底节高血压脑出血的临床疗效。方法对138例基底节区高血压脑出血患者采用小骨窗开颅,显微镜下清除血肿。结果术后24h内复查CT显示,117例血肿清除90%以上,21例血肿清除80%以上。死亡13例,其中5例死于术后再出血所致的脑疝,3例死于肺部感染,2例死于多器官衰竭,死于颅内感染、气道梗阻及消化道大出血各1例。术后生存125例,平均随访8(3～12)个月,日常生活能力(ADL)分级:Ⅰ级25例,Ⅱ级49例,Ⅲ级34例,Ⅳ级15例,Ⅴ级2例。结论小骨窗开颅显微手术创伤小,术野显露充分,血肿清除彻底,止血可靠,是治疗基底节高血压脑出血的有效手术方式之一。

Objective To explore the effectiveness of mini-invasive surgery for hypertensive basal ganglia hemorrhage by small skull-window craniotomy.Method All the 138 patients of hypertensive basal ganglia hemorrhage were performed the small skull-window craniotomy and hematoma clearance under microscope.Results The CT reexamination showed that hematoma was removed over 90% in 117 cases and over 80% in 21 cases within 24 hours after the operation.A total of 13 patients died,including 5 died of cerebral hernia associated with rehaemorrhagia,3 of pulmonary infection,2 of multiple organ failure,1 of intracranial infection,1 of airway obstruction and 1 of massive hemorrhage of gastrointestinal tract.125 cases survived and were followed up for 3 to 12 months with an average of 8 months.According to the activities of daily living（ADL） scale,the outcomes revealed that grade Ⅰ,Ⅱ,Ⅲ,Ⅳ and Ⅴ were 25,49,34,15 and 2 cases respectively.Conclusion Microsurgery via small skull-window craniotomy is one of the effective methods for hypertensive basal ganglia hemorrhage with the advantages of minimal invasion,sufficient operation field exposure,exhaustive clearance of hematoma and reliable hemostasis effect.