开颅血肿清除和硬通道穿刺治疗基底节区高血压脑出血的疗效对比

Comparison of Effects Between Craniotomy Evacuation of Hematoma and Hard Tunnel Minimally Invasive Perforation for Hypertensive Basal Ganglia Hemorrhage

目的：对比开颅血肿清除和硬通道穿刺治疗高血压基底节区脑出血的效果及预后。方法回顾性分析2005年1月～2013年12月我科192例高血压脑出血的临床资料，其中开颅血肿清除术（开颅组）和穿刺引流术（微创组）各96例。2组年龄、性别、血肿侧别及Glasgow昏迷评分差异无显著性（P＞0．05）。对比2组术中出血量、术后残余血肿量、手术时间、住院时间和术后3周及6个月的临床疗效。结果与开颅组比较，微创组手术时间短[中位数31（24～39） min vs．152（131～170）min，Z＝-11．975，P＝0．000]，术中出血少[30例0 ml、66例＜5 ml vs．（332．4±20．2）ml]，术后住院时间短[中位数14（10～17）d vs．64（44～75）d，Z＝-44．217，P＝0．000]，但术后残余血肿量多[中位数13（8～17）ml vs．7（4～12）ml， Z＝-11．573，P＝0．000]。治疗3周后，微创组Glasgow 预后评分高[中位数4（2～4）分 vs．3（1～4）分，Z＝-8．215，P＝0.000]，Barthel指数高[（59．9±4．5） vs．（54．9±4．9），t＝7．370，P＝0．000]。治疗6个月，微创组Glasgow预后评分高[中位数3（2～4）分vs．2（1～4）分，Z＝-7．448，P＝0．000]，Barthel指数高[（64．3±8．4） vs．（59．7±6．8），t＝4．156，P＝0．000]，2组病死率差异无显著性（P＞0．05）。结论微创颅内血肿硬通道穿刺引流术在一定程度上明显优于开颅血肿清除术，值得临床推广应用。

Objective To compare the effects and prognosis of craniotomy evacuation of hematoma and hard tunnel minimally invasive perforation for hypertensive basal ganglia hemorrhage （ HBGH ） . Methods A total of 192 patients with HBGH from January 2005 to December 2013 were retrospectively reviewed , including 96 cases of craniotomy evacuation of hematoma and 96 cases of minimally invasive puncture drainage .No significant differences were found in age , gender, lesion side,and Glasgow coma scale between the two groups （ P 〉0.05 ）.The intraoperative bleeding volume , postoperative residual hematoma , operation time, hospitalization duration , and the postoperative clinical curative effects at 3 weeks and 6 months after operation were compared between the two groups . Results As compared with the craniotomy group , the operation time of the hard tunnel minimally invasive perforation group was significantly shorter [31 （24 -39） min vs.152 （131 -170） min, Z =-11.975, P =0.000], the intraoperative blood loss was significantly less [0 ml in 30 cases and 0.05）. Conclusion Minimally invasive hard tunnel puncture drainage is significantly superior to craniotomy evacuation of hematoma in the treatment of HBGH and deserves to be promoted for clinical performance .