高血压脑出血破入脑室的手术治疗

Operative Treatment of Hypertensive Intracerebral Hemorrhage Broken into Ventricles

目的探讨高血压脑出血破入脑室不同手术方法的临床疗效;方法回顾性分析我院自2006年1月～2011年12月收治的106例高血压脑出血破入脑室患者的临床资料,根据不同手术方法,分为观察组(小骨窗开颅血肿清除术)和对照组(去大骨瓣开颅血肿清除术),根据GCS预后评估法比较两组患者疗效。结果观察组与对照组患者术后1月GCS评分均优于术前,且观察组治疗后1月GCS评分较对照组差异有统计学意义(P<0.05)。观察组治疗有效率为69.6%,死亡率14.3%,并发症率为8.9%;对照组治疗有效率为46.0%,死亡率20.0%,并发症率为22.0%,两组比较差异有统计学意义(P<0.05)。结论高血压脑出血破入脑室手术方式需依据患者具体情况进行选择,小骨窗开颅血肿清除术具有微创、效果明显、术后并发症少等优点,对于老年人、合并慢性疾病及血肿位置较深的患者可作为首选方法。

Objective The clinical effects of the different operative treatment methods on hypertensive intracerebral hemorrhage broken into ventricles were discussed in this paper. Methods 106 cases with hypertensive intracerebral hemorrhage broken into ventricles, who received a treatment in Guangzhou Hospital of Integrated Traditional and Western Medicine from January 2006 to December 2011, were retrospectively analyzed; these cases were classified into observation group （keyhole approach） and control group （the big bone petal to open the skull haematoma elimination）. According to GCS prognosis evaluation method, the treatment effects of the cases in two groups were compared. Results The GCS scores of the cases in two groups after 1 month of the operation were higher than those before the operation; the cases of observation group were significantly different （P〈0.05） from the cases of control group in the GCS scores after 1 month of the operation; the treatment effective rate, death rate, and complication rate of the observation group were 69.6%, 14.3%, and 8.9%, respectively; the treatment effective rate, death rate, and complication rate of the control group were 46.0%, 20.0%, and 22.0%, respectively. Therefore, in treatment effective rate, death rate, and complication rate, the difference between two groups was significant and of statistical significance （P〈0.05） . Conclusion The operation methods for the patients with hypertensive intracerebral hemorrhage broken into ventricles are necessarily selected according to the actual conditions of patients; keyhole approach features minimal invasion, significant effect, and less post-operation complications, and thus can be used as a primary method for the elder with complication chronic diseases and the patients with deep hematoma.