小骨窗开颅手术治疗老年性高血压脑出血51例临床分析

The enlarged burr-hole craniotomy for treatment of hypertensive intracerebral hemorrhage in geriatric patients

目的研究老年性高血压脑出血的微创治疗策略。方法回顾性分析51例应用小骨窗开颅技术治疗的老年(>65岁)高血压脑出血患者。均在直视下清除血肿,术后血肿残余大于15 ml者辅助尿激酶稀释液灌注引流。结果血肿近全清除36例,大部清除14例,再出血后二次手术清除1例。由于老年病人存在脑萎缩,血肿清除后减压均较充分。随访6个月至2年,GOS优28例,中残15例,重残7例,死亡1例。恢复良好率达84.3%。结论小骨窗开颅手术治疗高血压脑出血,具有微创、可视、省时、病人恢复快等优点。

Objective To investigate the strategy of minimally invasive treatment for hypertensive intracerebral hemorrhage in geriatric patients.Methods Review the clinical date of fifty-one aged patients（65years old） who were treated with the enlarged burr-hole craniotomy because of hypertensive intracerebral hemorrhage.All hematomas were evacuated under direct visualization.If the volume of residual hematoma on follow-up CT was more than 15ml,a drainage procedure would be performed after the perfusion of the urokinase.Results Nearly total evacuation of hematoma was achieved in 36 cases,subtotal evacuation in 14 cases,but in 1 case rebleeding occurred and reoperation was done.The decompression was sufficient because of the shrinkage of brain tissues in aged patients.Followed up for 6 months to 2 years,good recovery was found in 28 cases,moderate disability in 15 cases,severe disability in 7 cases and death in 1 case according to the glasgow outcome scale（GOS）.The rate of favorable outcomes was 84.3%.Conclusion The advantages of enlarged burr-hole craniotomy in the treatment of hypertensive intracerebral hemorrhage are minimally invasive,visible,less time consuming and quick recovery of patients.