高血压脑出血外科治疗的临床体会

Clinical Experience with Operative Treatment of Hypertensive Intracerebral Hemorrhage

目的探讨高血压脑出血3种手术治疗的疗效及其适应证。方法收集我院2005年1月至2011年4月采用颅骨钻孔血肿抽吸引流术、小骨窗显微手术血肿清除术及大骨瓣开颅血肿清除术3种术式治疗高血压脑出血63例,按照血肿量分为3个讨论组,并对3种不同术式的疗效和适应症作一分析。结果对高血压脑出血GCS评分较高(11～14分)、血肿量较小(20～50ml)的病人选用颅骨钻孔血肿抽吸引流术可降低致残率。血肿量较小(20～50ml)及中等量血肿(51～80ml)的病人采用小骨窗显微手术血肿清除术能明显减少死亡率。巨大血肿(>80mL)的病人采用骨瓣开颅能明显降低死亡率。结论手术治疗高血压脑出血的3种术式各有其优势及缺点。颅骨钻孔血肿抽吸引流术具有手术创伤小,病人恢复快,并能及时有效地解除脑受压的特点,但有较大再出血风险。大骨瓣开颅血肿清除术对患者的损伤大,患者康复时间长,但止血确切,可明显减少再出血风险。

Objective To explore the therapeutic efficacies of different surgical methods for hypertensive intracerebral hemorrhage and to investigate their indications. Methods Admitted into our hospital from January ,2005 to April ,2003,63 cases of hypertensive intracerebral hemorrhage（HICH） treated by the cranial drilling hematoma aspiration, craniotomy through small bone window or craniotomy through bone flap was divided into 3 subgroups according to hematoma volume. To analyzed the indications and therapeutic outcomes of these 3 surgical methods comparatively. Results The disability rate was low in the cranial drilling hematoma aspiration group with GCS 11-14 and small hematoma volume （20-50ml）.The patients＇ morbidity was reduced obviously in small-bone-window craniotomy group with the small hematoma volume （20-50ml） and moderate hematoma volume（51-80ml）. The bone-flap craniotomy group with great hematoma volume （over 80ml） has a low mortality rate. Conclusion The 3 surgical methods for hypertensive intracerebral hemorrhage have their advantages and disadvantages respectively. The cranial drilling hematoma aspiration has the marked superiorities such as minimal invasion and quick rehabilitation and immediate decompression. But there was a higher rate of recurrent hemorrhage after the cranial drilling hematoma aspiration. Althought there is more injury and lead to longer time to healing, the method of craniotomy through bone flap obviously reduce the rate of recurrent hemorrhage after the operation.