高血压脑出血合并脑疝超早期手术方法探讨

Investigation of ultra-eraly surgical treatment for hypertensive cerebral hemorrhage complicated brain hernia

目的比较大骨瓣开颅血肿清除并去骨瓣减压和小骨窗开颅血肿清除两种术式超早期治疗高血压脑基底节出血脑疝的疗效。方法回顾性分析72例重症高血压脑基底节出血脑疝病人的临床资料,32例行大骨瓣开颅血肿清除并去骨瓣减压4,0例行小骨窗开颅血肿清除。随访6个月,综合比较其临床疗效、血肿清除率及手术并发症。结果两组在血肿清除程度,术后并发症发生率(除外消化道出血),死亡率及6个月随访疗效等方面无显著差异,在术后消化道出血发生率、手术时间及输血量等方面小骨窗组优于大骨瓣组(P<0.05)。结论在高血压脑出血脑疝病人超早期手术治疗中,小骨窗开颅血肿清除术可作为首先考虑的手术方式。

Objective： To compare the clinical effects of large trauma craniotomy on hematoma removal and hematoma clearance in small bone-window perestration in super early stage for treating hypertensive cerebral hemorrhage and cerebral hernia.Methods： Retrospective analysis was made in the 72 cases of basal ganglia hemorrhage in hypertensive cerebral herniation with severe clinical data.Thirty-two cases of such patients were treated with large trauma craniotomy for hematoma removal and 40 cases of such patient were treated with small bone-window perestration.Follow-up continued for 6 months,comprehensive comparison was made about its clinical efficacy,hematoma rate and complications rate of surgery.Results： Differences between two groups in evacuation rate,complications of surger y（except for gastrointestinal bleeding）,mortality and follow-up on 6-month were not significant,and the gastrointestinal hemorrhage rate of surgery,surgery time and blood transfusion were significantly higher in the small bone-window perestration group than those in large trauma craniotomy group（P0.05）.Conclusion： Hematoma clearance in small skull hole is the first choice for treating hypertensive cerebral hemorrhage and cerebral hernia in super early stage.