1310例高血压脑出血手术疗效总结

A multicentre retrospective analysis of surgical effects of the 1310 Hypertensive intracerebral hemorrhage

目的探讨高血压脑出血各种术式与出血部位、出血量、手术时机及结局的关系。方法对6所医院神经外科2004年1月至2012年1月住院手术的1310例患者，按骨瓣开颅（A组）、小骨窗手术（B组）、定向置管引流（C1组、c2组）、神经内镜手术（D组）、脑室置管引流（E组）的手术方式分为6组，结合出血部位、出血量及临床实际，对选择手术时机和术式的疗效进行回顾性分析。结果①80mL以上的深、浅部血肿致脑疝中晚期，宜选用骨瓣开颅。②50—80mL的深、浅部血肿，宜选用定向置管弓l流或神经内镜手术。③20～50mL的深、浅部血肿，宜选用定向置管引流。④脑室出血宜选用置管引流；脑室铸型宜选用神经内镜手术。⑤80mL以下出血手术时机6～12h为妥，出血量大应及时手术以挽救生命，要根据病人的具体情况灵活掌握。结论高血压脑出血大量出血或脑疝以骨瓣开颅为妥，80mL以下血肿以定向置管引流为宜，也要根据出血部位、出血量，选择手术时机和手术方式，个体化治疗才能进一步提高疗效。

Objective To explore the relationship between different hemorrhage position, hemorrhage volume , surgical time and outcome of treatment with surgical methods of HICH. Methods A total of 1310 patients were admitted from six hospitals from January 2004 to January 2008, the 1310 patients were divided into six groups according to different operation： craniotomy through bone flap （group A）, craniotomy through small bone window （group B）, stereotaetie drilling drainage （group C1 and group C2）, neuron-endoscopy operation （group D ） and external ventricular drainage （group E ）, considering hemorrhage position, hemorrhage volume, surgical time and result of surgical methods were reviewed and analyzed. Results Craniotomy through bone flap should be selected with the case of superficial or deep hematoma volume （ 〉 80 mL）, median line structure distinct motion, metaphase or advanced stage of hernia of brain. Craniotomy through small bone window and neuron-endoscopy should be selected with the case of moderate hematoma volume （50-80 mL） Drilling drainage should be selected with the case of small hematoma volume in superficial or deep hematoma volume （20-50 mL）External drainage should be selected in dealing with ventricular hemorrhage. Small bone window or neuron-endoscopy should be selected in ventricular casting mould. The appropriate operation time for patients with hematoma volume less than 80 mL should be 6-12 hours and large hematoma should be immediately operated to save lives. The operation time should depend on patients detail condition. Conclusions Craniotomy through bone flap was suitablefor large hematoma and hernia of brain; Stereotactic drilling drainage should be selected in patients with hematoma volume less than 80mL; and the operation results in dealing with HICH would be improved via suitable operation time and surgical methods and adividual according to Hemorrhage position and Hemorrhage volume.