自发性小脑出血45例治疗与分析

Treatment and analysis on 45 cases with spontaneous cerebellar hemorrhage

目的探讨小脑出血的手术适应证和治疗方法。方法总结我科1998年3月～2010年5月经影像学确诊的资料完整的45例自发性小脑出血住院患者,16例经颅后窝正中入路行血肿清除术;29例经脱水、止血等药物治疗。结果手术组治愈11例,病死4例,植物生存状态1例。治愈率68.8%,病死率25.0%。药物治疗治愈21例,好转2例,血肿大部分吸收后自动出院2例,死亡4例。治愈率72.4%,病死率13.8%。总体治愈率7l.1%,病死率17.8%。结论血肿量>15ml、血肿位于蚓部和半球混合性出血、血肿累及脑干和/或破入第四脑室者、急性梗阻性脑积水者,为防止脑疝形成应尽早手术治疗。

Objective To evaluate the surgical indications and treatment of spontaneous cerebellar hemorrhage.Methods To retrospectively analyze 45 cases of spontaneous cerebellar hemorrhage during 1998 to 2010,which were made the definite diagnosis by the CT and/or MRI and had the complete data.16 cases among them underwent the surgical treatment by the midline posterior cranial fossa approach,the remaining 29 cases adopt the treatment of dehydration and hemastasis.Results In surgical treatment group,11 cases were recovery（68.8%）,4 cases were death（25.0%） and 1 case was in persistent vegetative state.Relatively in medicine treatment group,21 cases were restoration（72.4%）,2 cases were improvement,2 cases were automatic discharge,4 cases were death（13.8%）.Among 45 cases,the recovery rate was 71.1%,the mortality rate was 17.8%.Conclusion When the hematoma volume exceeds 15ml,hematoma is synchronously situated at cerebellar vermis and hemisphere,hematoma constricts brain stem and/or breaks into the fourth ventricle,there is the acute obstructive hydrocephalus,the operation must be taken as soon as possible in order to prevent the occurrence of cerebral herniation.