自发性脑出血的外科手术治疗

Surgical treatment of spontaneous intracerebral hemorrhage

脑出血（intracerebral hemorrhage，ICH）是第2位常见的卒中类型，其病死率很高。基线血肿体积和血肿增大是患者转归不良的预测因素。早期研究显示，手术血肿清除可缩小血肿体积并改善转归。然而，最近的几项颅骨切除血肿清除术治疗ICH的随机对照试验和汇总分析均显示其并不比保守治疗更能获益。微创血肿清除术治疗ICH的早期证据提示其对ICH患者具有潜在的益处，但还需要进一步的研究确认。

Intracerebral hemorrhage （ICH） is the second most common type of stroke, and its fatafity is high. The baseline hematoma volume and hematoma growth are the predictive factors for the poor outcome of the patients. Previous studies have shown that surgical evacuation of hematoma can reduce the hematoma volume and improve the outcome. However, several recent randomized controlled trials of craniotomy hematoma evacuation for ICH and a Meta-analysis have shown that it is no more beneficial than conservative treatment. The previous evidence of minimally invasive evacuation of hematoma for the treatment of ICH has suggested that it has potential benefits for patients with ICH; however, further research is needed to confirm it.