脑立体定向微创技术治疗颅内出血降低术后继发性癫癎发生率

Stereotacticly minimal-invasive procedure for evaluation of intracranial hematoma in the reduction of the incidence of postoperative epilepsy

目的观察立体定向微创技术治疗颅内出血术后继发性癫癎的发生率。方法：高血压性脑出血患者60例，平均年龄43．52岁，血肿量为30～50 mL，平均（38．33±2．8）mL。患者入院后随机分为立体定向微创治疗组及开颅血肿清除术组各30例，人院24 h内进行微创血肿清除术或开颅血肿清除术，2组患者均予常规药物治疗如降颅压、调节血压、止血、预防感染等。手术治疗后3、6、12个月时随访，以患者继发性癫癎发生率及美国国立卫生研究院卒中量表（NIHss）评分为指标，评估其神经功能恢复情况及继发性癫癎发生情况。结果：立体定向微创组3个时间段继发性癫癎的发生率分别为6．7％、10％、10％，NIHSS评分分别为（6．23±2．02）分、（5．50±2．21）分、（4．80±1．20）分；开颅血肿清除术组3个时间段继发性癫癎的发生率分别为60％、60％、53％，NIHSS评分分别为（10．18±2．20）分、（8．20±2．20）分、（7．43±2．22）分；2组间比较，继发性癫癎及NIHSS评分的差异有统计学意义（P〈0．01）。结论：立体定向微创治疗高血压性脑出血可以明显降低继发性癫癎发生率，改善患者神经功能，有利于并提高患者的生活品质。

Objective：To observe the incidence of postoperative epilepsy in patients with intracerebral hemorrhage（ICH） treated by stereotaetic minimally invasive procedure. Methods： Sixty patients with hypertensive ICH were included in this study, who were aged from 42 to 59 years,mean 43.52 years. The volume of the hematoma was 30-50 ml,mean 38.33±2.8 ml. The patients were randomly derided into the stereotactic minimally invasive group （MI group, 30 cases and the conventional craniotomy group （CC group, 30）. The MI procedures were performed in the MI group to evaluate the intracerebral hemor rhage in 24hours after onset of ICH. The CC group received open surgical procedures for clearance of the herrlatoma. Both the two groups received conventional medication The incidence of postoperative epilepsy and National Institute of Health Stroke Scale （NIHSS） in one month, three month or six month respectively after operation were used to evaluate the outcome of patients after surgery. Results： The incidence of pos.toperative epilepsy in three stages time in MI group was 6.7%, 10%, 10% respectively. A significant difference was observed compared with those in the CC group（60%, 60%, 53%）. The NIHSS [（6.23±2.02）,（5. 50±2. 21）,（4. 80± 1.20）] displayed a significant decrease compared with the CC group. Conclusion： Stereotactic minimally invasive procedures for evaluation of intracerebral hematoma might decrease the incidence of postoperative epilepsy and improve the outcome.