自发性脑叶出血的手术治疗方法和策略

The Surgical Methods and Strategies on Spontaneous Brain Hemorrhage

目的：探讨自发性脑叶出血的手术治疗方法和策略，评估救治效果。方法：回顾总结60例脑叶出血手术患者，采用个体化手术方法的治疗经验，其中钻孔引流术19例，开颅手术41例。术前脑血管影像检查36例，手术时机3~6 h、6~12 h和〉12 h的患者分别为19、23、18例。结果：经外科手术治疗后，血肿减少率高达79.20%，术后再出血率为15.00%，其中6~12 h和〉12 h术后再出血率均明显低于3~6 h手术患者（P〈0.05）；术后7 d、4周的神经功能恢复较3~6 h手术患者差（P〈0.05），但较术前、术后1 d改善明显（P〈0.05）。随访6~12个月，恢复良好28例（46.67%），中残20例（33.33%），重残6例（10.00%），植物生存1例（1.67%），死亡2例（3.33%），放弃治疗3例（5.00%）；ADLⅠ31例（50.67%）；ADLⅡ17例（28.33%）；ADLⅢ10例（16.67%）；ADLⅣ2例（3.33%）；手术优良率高达96.67%。结论：自发性脑叶出血的手术治疗，术前应尽量行脑血管影像检查，尽量使用手术显微镜，根据血肿体积、出血部位和出血原因选择正确的手术方法和策略，准确把握早期手术时机，而非超早期手术，争取达到最佳的手术止血效果和神经功能恢复疗效。

Objective：To explore the surgical methods and strategies on spontaneous brain hemorrhage. Method：According to individual operation experience,60 brain hemorrhage surgery patients were retrospective summarized,36 cases were given preoperative cerebral imaging,60 patients were divided into two groups,19 cases for drilling drainage group,41 cases for surgical operation groups. According operation time,the patients were divided into three groups：3-6 h,6-12 h and〉12 h group were respectively for 19,23,18 cases. Result：After surgery,hematoma loss was as high as 79.20%,postoperative rebleeding rate was 15.00%,postoperative rebleeding rate of 6-12 h and〉12 h were obviously lower than 3-6 h surgical patients（P〈0.05）,but nerve function recover of 7 days,4 weeks were worse than 3-6 h surgery（P〈0.05）,and significantly improved than preoperative and postoperative 1 day after surgery（P〈0.05）,followed up for 6-12 months,28 cases recovered well（46.67%）and 20 cases moderate disability（33.33%）,6 cases severe disabilities（ 10.00%）, plant survival for 1 case（ 1.67%）, 2 cases died（ 3.33%）, given up treatment for 3 cases（ 5.00%）; ADL Ⅰ for 31 cases（ 50.67%）, ADL Ⅱ for 17 cases（ 28.33%）, ADL Ⅲ for 10 cases（ 16.67%）, ADL Ⅳ for 2 cases （3.33%）; surgery effective rate was as high as 96.67%. Conclusion： Operation of spontaneous intracerebral hemorrhage should be given preoperative cerebrovascular imaging and used microscope, choose operation methods and strategies correctly by volume of hematoma, bleeding cause and location, it will get the best recovery effect on hemostasis operation and nerve function by the way of grasp operation time early but non- ultra early operation accurately.