296例高血压性脑出血显微外科微创治疗分析

Therapeutic effect of microsurgical technique with Key hole approach for 296 cases of hypertensive intracranial hemorrhage

目的探讨高血压性脑出血患者采用显微外科联合小骨窗微创治疗后的效果,指导临床术式选择。方法回顾性分析单纯小骨窗手术139例,显微外科联合小骨窗微创手术157例,按照颅内血肿清除率、术后大面积脑梗死发生率评定手术效果,按照日常生活能力表(ADL)分级评定预后进行统计分析。结果术后血肿残留、术后大面积脑梗死发生率和预后分级有统计学差异,显微外科联合小骨窗组各项指标优于单纯小骨窗手术组。结论显微外科联合小骨窗微创手术治疗高血压性脑出血,能提供良好的照明和视野,并且提高病变的放大视觉效果,能够直视下清除血肿,提高血肿清除率,减少了术后大面积脑梗死的发生,有利于改善患者预后。

Objective To investigate the microsurgical technique with Key hole approach for hypertensive intracranial hemorrhage Methods 139 patients were operated only with Key hole approach and 157 patients were operated with Key hole approach with microsurgical technique,respectively The clearance percentage,incidence rate of mass area infarction,score of ADL were retrospectively analyzed and compared between two groups Results The clearance percentage and incidence rate of mass area infarction in group with Key hole approach with microsurgical technique were significantly lower than those in group only with Key hole approach（15.8%vs 7.6%,8.6%vs 3.2%,both P0.05）;meanwhile,the score of ADL in group with Key hole approach with microsurgical technique was significantly higher than another（70.7%vs 59.7%,P0.05） Conclusion Key hole approach with microsurgical technique can provide good illumination and the field of vision,enhances pathological change＇s enlargement vision effect,raises the haematoma clearance percentage,reduces the incidence rate of mass area infarction,and improves prognosis of patients.