高血压壳核出血开颅手术的策略与技巧研究

Strategies and techniques of craniotomy for hypertensive putamen hemorrhage

目的回顾性分析应用显微技术小骨窗开颅手术治疗高血压壳核出血120例的治疗效果，探讨开颅手术的策略与技巧。方法高血压壳核出血120例，开颅手术，在距额骨颧突8em，围绕外侧裂的体表线，额颞弧形切口，做直径4cm的骨窗，在中央前回下点外侧裂上缘无血管处前后方向切开皮层2～3cm。用1cm宽的脑板分开至血肿腔清除血肿，然后在显微镜下操作，清除残余血肿，电凝止血。术后控制血压，保持引流管通畅，12h复查cT，评价手术效果。结果血肿清除80％以上98例（82．0％），全部清除65例（54．1％），再出血5例（4．1％）。血肿全部清除者未发生明显的脑水肿，脑结构恢复较早较好。随访9个月～4年，GOS评分：恢复良好25例（20．8％），轻残20例（16．6％），中残37例（12．5％），重残23例（19．2％），死亡15例（12．5％）。结论应用显微技术小骨窗开颅手术治疗高血压壳核出血，创伤小，治疗效果好。

Objective To retrospectively analyze the treatment effect of craniotomy on 120 cases of hypertension putamen hemorrhage by microsurgical techniques with small bone window, and investigate the strategies and techniques of eraniotomy. Methods One hundred and twenty cases of hypertensive putamen hemorrhage had craniotomy, at a distance of 8 cm from zygomatic process of the frontal bone, a- round the surface the lateral fissure lines, with frontotemporal curved incision, made a bone window of 2 -4 cm in diameter, longitudinal incision with the diameter 2 -3 cm were made on the no vessels edge of the cortex in the lower part of the central gyrus and top part of lateral fissure. The brain tissue was sep- arated with 1 cm wide plates and the hematoma was removed, and then the residual hematoma was re- moved under the operating microscope, and the vessels were coagulated. Controlled the blood pressure and maintain drainage tube patency postoperatively, CT scan were made to evaluate surgical results after 12 hours. Results Hematomas were removed in more than 80% of the 98 eases（82.0% ） , totally re- moved in 65 cases （54. 1% ）, rebleeding in 5 cases （4. 1% ）. Patients with hematoma totally removed showed no significant cerebral edema, brain structure restored earlier and better. Followed up for 9 months to 4 years, GOS score： good recovery in 25 cases （20. 8% ）, mild disability in 20 cases （16.6%） , moderate disability in 37 cases（12. 5% ） , severe disability in 23 cases（ 19.2% ） , 15 cases （ 12.5% ） died. Conclusions The method to treat the hypertension putamen hemorrhage by microsurgi- ca1 techniques with small bone window is feasible, with little trauma and better treatment effect.