三种手术方式治疗基底节区脑出血的疗效分析

Clinical outcomes of three operation mode in treatment of basal ganglia cerebral hemorrhage

目的：探讨小骨窗开颅术、改良标准外伤大骨瓣开颅术、CT定向血肿穿刺吸引术等三种手术方式，治疗基底节区脑出血的治疗策略、手术适应征及疗效与基底节区脑出血的手术方式选择。方法神经外科格拉斯哥评分（GCS评分）≤12分的基底节区脑出血手术患者327例。（GCS 3分8例，GCS 4分12例，GCS 5分36例，GCS 6分50例，GCS 7分47例，GCS 8分45例，GCS 9分56例，GCS 10分43例， GCS11分18例，GCS 12分12例）。其中采用小骨窗开颅术171例，改良标准外伤大骨瓣开颅术133例，CT定向血肿穿刺吸引术23例。所有患者都经CT扫描证实基底节区脑出血状况。结果出院后3个月，小骨窗开颅组恢复良好93例，中残50例，重残22例，植物生存5例，死亡1例；改良标准外伤大骨瓣开颅组恢复良好47例，中残59例，重残24例，植物生存2例，死亡1例。术前GCS（3～7）分改良标准外伤大骨瓣开颅组恢复良好率最高，术前GCS（8～12）分小骨窗开颅组恢复良好率最高，差异均有统计学意义（P〈0.05）。结论术前GCS（3～7）分的基底节区脑出血患者改良标准外伤大骨瓣开颅术的疗效可优于小骨窗开颅术、CT定向血肿穿刺吸引术。术前GCS（8～12）分的基底节区脑出血患者小骨窗开颅术的疗效可优于改良标准外伤大骨瓣开颅术、CT定向血肿穿刺吸引术。

Objective To observe the treatment strategies, operation indications, curative effect and operation mode choice of 3 kinds of operation mode：small bone window craniotomy, modified standard large trauma craniotomy and CT guided hematoma puncture and aspiration in treating basal ganglia cerebral hemorrhage. Methods 327 cases of basal ganglia cerebral hemorrhage and undergoing with operation with Neurosurgery Glasgow Score （GCS）〈12 points were retrospectively studied （ GCS 3 points 8 cases, GCS 4 points 12 cases, GCS 5 points 36 cases, GCS 6 points 50 cases, GCS 7 points 47 cases, GCS 8 points 45 cases, GCS 9 points 56 cases, GCS 10 points 43 cases, GCS 11 points 18 cases, GCS 12 points 12 cases）. 171 cases were operated by small bone window craniotomy, 133 cases by modified standard large trauma craniotomy, 23 cases by CT guided hematoma puncture and aspiration. All patients were confirmed with basal ganglia cerebral hemorrhage by CT scan. Results 3 months after discharge, Small bone window craniotomy group：good re-covery in 93 cases, moderate disability in 50 cases, severe disability in 22 cases, vegetative state in 5 cases,death in 1 case. Modified standard large trauma craniotomy group：good recovery in 47 cases, moderate disability in 59 cases, severe disability in 24 cases, vegetative state in 2 cases, death in 1 case. Good recovery rate of modified standard large trauma craniotomy group in GCS （3-7） points from preoperative was best. Good recovery rate of small bone window craniotomy group in GCS（8-12） points from preoperative was best. All their differences had statistical significance （P〈0.05）. Conclusion In preoperative GCS （3-7） points basal ganglia cerebral hemorrhage patient, curative effect of modified standard large trauma craniotomy was better than small bone window craniotomy, CT guided hematoma puncture and aspiration. In preoperative GCS （8-12） points basal ganglia cerebral hemorrhage patient,curative effect of small bone window craniotomy was better than modified standard large trauma craniotomy, CT guided hematoma puncture and aspiration.