简易经额定向穿刺术治疗高血压基底节区脑出血的研究

Study on simplified trans-frontal stereotactic puncture evacuation in treatment of hypertensive basal ganglia hemorrhage

目的：探讨简易经额定向穿刺术治疗高血压基底节区脑出血的效果。方法自2012年10月～2015年6月采用简易经额定向穿刺术治疗高血压基底节区脑出血患者37例，总结分析患者术前临床资料、术中情况及术后疗效。结果本组患者中合并脑疝7例（19％），超早期手术13例（35％）；术中平均血肿抽吸率为32％（10％～65％），血肿部分抽吸后见脑皮质塌陷；术后并发症的发生率为22％，其中再出血率5％；术后30 d内的死亡率为0，术后6个月的预后良好率为92％（ADL Ⅰ～Ⅲ级）。结论简易经额定向穿刺术治疗高血压基底节区脑出血简单实用，适应证广，安全有效；而把握好手术时机和注重围手术期细节管理是疗效好的保障。

Objective To explore the effects of simplified trans-frontal stereotactic puncture evacuation in the treatment of hypertensive basal ganglia hemorrhage .Methods From October 2012 to June 2015, 37 patients with hypertensive basal ganglia hemorrhage were treated with simplified trans-frontal stereotactic puncture evacuation .Pre-operative clinical data , operation details and post-operative curative effects were recorded .Results 7 patients complicated with brain herniation .13 patients accepted surgery within 7 h after cerebral hemorrhage .Mean aspiration rate was 32%. Cortex sank after partial hematoma aspirated . Post-operative complication rate was 22%, rehemorrhage rate was 5%.No patients died within 30 d after operation .Judged by ADL , 92 percent of patients achieved good outcome （ grade I to III ） after 6 months of follow-up.Conclusions Simplified trans-frontal stereotactic puncture evacuation is a simple , practical , safe and effective method to treat hypertensive basal ganglia hemorrhage .Surgical timing and good management during perioperative period are the key to achieve good outcomes .