超早期小骨窗显微手术治疗自发性脑出血血肿58例临床分析

Clinical analysis on ultra early small window microscopic craniotomy treatment of spontaneous intracranial hematomas in 58 cases

目的探讨超早期小骨窗显微手术清除自发性脑出血血肿的方法和疗效。方法对58例昏迷、无脑疝症状的自发性脑出血脑内血肿形成的患者,在显微镜下实施超早期小骨窗血肿清除术,分析手术疗效。结果术后24h后复查头颅CT,血肿清除95%者45例,血肿清除85%以上者13例,无再出血造成脑疝形成者。术后随访6个月以上,术后存活55例,按日常生活能力进行分级,Ⅰ级41例,Ⅱ级10例,Ⅲ级3例,Ⅳ级1例。结论超早期小骨窗显微手术创伤小、止血充分、恢复周期短、可有效提高患者生存率和生活质量,是清除自发性脑出血形成的脑内血肿比较理想的手术方式。

Objective To discuss the method and effect about removing the spontaneous intracranial hematomas through small window microscopic craniotomy in super early stage.Methods A total of 58 cases of coma in patients with spontaneous intracranial hematomas,no symptoms of cerebral hemorrhage,were treated with ultra early small window microscopic craniotomy.Finally,the curative effect of the operation was analyzed.Results 24 hours after operation,the postoperative head CT scan performed revealed that over 95% volume of hematoma was removed in 45 patients,and more than 85% volume of hematoma was removed,and none of them had cerebral herniation caused by rehaemorrhagia.Among these cases,55 cases were survival,following up the 55 living cases that had the operation after 6months.According to the activities of daily living evaluation,the prognosis can be divided into 5level from good to bad.There were 41 cases in Level I,10 cases in LevelⅡ,3cases in LevelⅢ,and 1cases in Level IV.Conclusion The operation about removing the intracerebral hemorrhage by small window microscopic craniotomy in super early stage has many advantages.For example,it has less injury,fully hemostasia,short recovery cycle,and increasing the patients,rate of survivor and living quality.So this operation is a better way to remove the spontaneous intracranial hematomas.