壳核区高血压脑出血38例开颅手术治疗体会

Surgical Management of 38 Cases with Hypertensive Putamen Hemorrhage

目的探讨壳核区高血压脑出血的临床表现、手术指征、手术时机、手术方法及其预后。方法回顾性分析2010年4月-2011年11月收治的38例壳核区脑出血患者(男∶女=19∶19)的临床资料、手术治疗方法、效果及预后。38例患者的诊断均符合美国成人自发性脑出血治疗指南(2010)的诊断标准,手术方法包括开颅血肿清除术,根据术前有无脑疝、术中脑压情况,决定是否去骨瓣,如合并脑室出血、脑积水则同时行脑室外引流术。结果术后住院期间死亡1例,放弃治疗8例,随访29例,病情稳定后出院时GOS评分5分14例,4分9例,3分5例,2分1例,29例随访病人门诊和电话随访时间6个月以上,死亡1例。结论壳核区脑出血开颅手术死亡率低,手术方法应个体化。

Objective To explore the clinical manifestation, surgical indication, time of operation, therapy methods and prog- nosis of hypertensive putaminal hemorrhage. Methods A retrospective analysis of the clinical data, treatment, efficacy and prog- nosis of 38 cases（ Male ：female = 19： 19 ） with hypertensive putaminal hemorrhage from April 2010 to November 2011 in our hos- pital was made. All 3g patients met the Guidelines for the management of spontaneous intracerebral hemorrhage in adults （AHA 2010）. The hematoma evacuation by craniotomy was performed in all cases, and bone flaps were removed or preserved according to the preoperative existence of brain herniation or intraoperative pressure. The external ventricular drainage was performed in ca- ses with ventricular hemorrhage or hydrocephalus. Results Of the 38 patients, 1 case died during hospitalization, 8 cases aban- doned the treatment, and 29 cases were followed up. The GOS score at discharge was 5 points in 14 patients ,4 in 9 cases,3 in 5 cases, and 2 in 1 cases. The follow-up time was 6 months. 1 case died during follow-up period. Conclusion The surgical treat- ment does not increase the mortality of patients with hypertensive putaminal hemorrhage, and the individualized treatment of oper- ation should be selected.