不同手术方式治疗高血压基底节区出血对比研究

Comparative study on different neurosurgical procedures for hypertensive basal ganglia hemorrhage

目的探讨3种治疗高血压基底节区出血手术方式的优缺点,选择适当的外科治疗方法。方法回顾分析2007年1月~2015年11月手术治疗的457例高血压性基底节出血患者的临床资料。比较采用骨瓣开颅血肿清除术、小骨瓣开颅血肿清除及锥颅血肿引流术式患者术后颅内压变化、并发症的发生及其预后。结果术后24 h后常规骨瓣开颅组颅内压较小骨瓣组低;小骨瓣组及锥颅组较常规骨瓣开颅组肺部感染、气管切开率、腹胀发生率高,3组消化道出血发生率的差异无统计学意义;锥颅组再出血率及死亡率较常规骨瓣组及小骨瓣组高,骨瓣开颅组与小骨瓣开颅组死亡率的差异无统计学意义;骨瓣开颅组的恢复良好率高于小骨瓣开颅组及锥颅组。结论不同手术方式有不同的适应证,个体化治疗,利用微创理念和显微神经外科技术治疗高血压基底节出血,可以减少并发症及死亡率,提高生存质量,改善预后。

Objective To investigate the three neurosurgical procedures for the hypertensive basal ganglia hemorrhage and select a proper surgical treatment for individual.Methods The clinical data of 457 patents with hypertensive basal ganglia hemorrhage from January 2007 to November 2015,treated by neurosurgical procedures,were reviewed retrospectively.The comparison of intracranial pressure,occurrence of complications and neurological outcome in the three groups who were treated by conventional open craniotomy （COC）,small craniotomy （SC） and skull puncture and drainage （SPD） were performed.Results The values of intracranial pressure were lower in the group of COC than that of SC after 24 hours post operation.The incidence of pulmonary infection,incision of tracheal and abdominal distension in the group of COC was lower than that of SC and SPD.And there were no difference between the three groups in the incidence of alimentary tract hemorrhage.Moreover,the incidence of postoperative re-bleeding and mortality were higher in SPD group,in comparison with COC and SC group.There was no significant difference in mortality between the COC and SC groups.The well rate in the COC group is better than that of SC group and SPD group.Conclusion Different neurosurgical procedures have different indications.The neurosurgery through the individualized approach and microneurosurgical technique may decrease the complications and mortality and improve prognosis in the patient with hypertensive basal ganglia hemorrhage.