自发性小脑出血的外科治疗

Surgical treatment in patients with spontaneous cerebellum hemorrhage

目的探讨经外科治疗自发性小脑出血的疗效及方案。方法自发性小脑出血患者37例,手术治疗31例,依据血肿部位可分别采用CPA"S形"入路、旁正中入路、后正中入路。显露枕大孔后缘甚至寰椎后弓,骨窗开颅,显微镜下清除血肿。结果血肿残余量在<20%28例,残余量>20%3例,术后死亡2例。随访病例中,小脑齿状核出血者多为眩晕及肢体共济失调为主症,蚓部出血者以躯体平衡障碍为主症,吞咽功能障碍多在咽期困难。结论手术治疗自发性小脑出血,显微镜下清除血肿,加强术后管理,疗效良好。

Objective To explore the effect of surgical treatment on spontaneous cerebellum hemorrhage by retrospective analysis .Methods 37 cases with spontaneous cerebellum hemorrhage were involved in this study ,and 31 cases received surgi‐cal treatment .Surgical options adopted“S -shaped”CPA approach ,paramedian approach ,posterior midline approach based on the localization of cerebellum hemorrhage .We revealed the posterior rims of foramen magnum and even the posterior arch of lepospondylous ,and then removed hematoma under microscope .Results Less than 20 percent of residual hematoma occurred in 28 cases and 3 cases had more than 20 percent .2 cases died after operation .In follow‐up cases ,patients with cerebellar den‐tate nucleus hemorrhage had main manifestations of giddiness and limb ataxia ,patients with cerebellum vermis hemorrhage suf‐fered from balance function disorder .Pharyngeal dysphagia happened in the period of swallowing difficulty .Conclusion Surgi‐cal treatment has an benign effect on spontaneous cerebellar hemorrhage when removing hematoma through microscope and strengthening the management of post-operation .