微侵袭手术治疗高血压脑出血

The minimally invasive operations of hypertenstive intracerebral hemorrhage

目的为了了解微侵袭手术治疗脑出血适应证、禁忌证，以及影响预后的因素如血肿量、手术时机、血肿破入脑室、再出血等。方法自1997年～2000年间运用计算机体层摄影（CT）定位，通过脑立体定向和神经内窥镜技术、小骨瓣开颅、脑室穿刺术治疗高血压脑出血，术后用尿激酶溶解共50例。结果手术1个月后按GOS临床评分方法评定近期疗效：优8例，良14例，中14例，差12例，死亡2例。术后6个月生存质量按ADL评分：ADL110例，ADL216例，ADL312例，ADL410例，ADL5O例。结论通过比较病情分级、血肿量、手术时机、血肿是否破入脑室与疗效的关系。我们认为病人临床分级轻、中型，血肿量在15～40ml之间，手术时机以发病后24～72h内运用脑立体定向穿刺＋纤溶治疗效果最佳。

Objective To approach the surgical indications, contraindications and factors affecting the prognosis sueh as volume of hematoma, timing of surgery, ventricular perforation and rebleeding. Method 50 cases with hypertensive hematomas were treated by CT-guided urokinase-injection and aspiration and endoscopic neurosurgery from 1997 to 2000. Result The patients were evaluated according to neurological GOS grades one month postoperative: excellent results were achieved in 8 cases,good in 14 cases; moderate in 14; bad in 12 cases and 2 cases died. The patients were evaluated according to neurological ADL grade 6 months after operation: ADL, in 10 cases, ADL2 in 16 cases, ADL3 in 12 cases, ADL4 in 10 cases. Conclusion We compared the curative effect with illness grade, volume of hematomas, timing of surgery and ventricular perforaion. The stereotactic puncture and dissolve is a good choice for the patient classified light and moderate type, volume of hematoma between 15ml to 40ml, timing of surgery between 24 to 72 hours.