高血压性小脑出血的手术治疗

Surgical treatment of hypertensive cerebellar hemorrhage

目的探讨高血压小脑出血的手术方法及疗效。方法回顾性分析2011年9月至2014年3月收治的30例高血压小脑出血患者的临床资料。22例行侧脑室外引流并骨窗开颅血肿清除术,8例单纯行侧脑室外引流术。结果术后6个月存活26例,死亡4例。存活者术后6个月时按日常生活能力量表(ADL)评价疗效:Ⅰ级3例,Ⅱ级14例,Ⅲ级6例,Ⅳ级2例,Ⅴ级1例。结论根据高血压小脑出血的血肿部位、出血量、脑积水情况和临床症状,及时行侧脑室外引流术及血肿清除术或侧脑室外引流术,是提高救治成功率、改善预后的有效手段。另外,脑室内注射纤溶制剂的安全性及价值有待于更多的研究加以证实。

Objective To investigate the surgical treatment of hypertensive cerebellar hemorrhage and the therapeutic effect.Methods The clinical data of 30 patients with hypertensive cerebellar hemorrhage who were admitted to our hospital from September2011 to March 2014 were retrospectively analyzed. Twenty-two patients underwent bone window craniotomy to remove the hematoma after external ventricular drainage,and 8 patients underwent external ventricular drainage alone. Results Twenty-six patients survived and 4 patients died at 6 months after operation. The clinical outcomes of survivors were evaluated according to activities of daily living at 6 months after operation： 3 in grade I,14 in grade Ⅱ,6 in grade III,2 in grade IV,and 1 in grade V. Conclusions Based on the site of hematoma,volume of hematoma,hydrocephalus,and clinical features,external ventricular drainage combined with hematoma evacuation or external ventricular drainage alone is the most effective treatment that can increase the success rate in treatment and improve the clinical outcomes. The safety and value of intraventricular fibrinolysis need to be confirmed by more research.