小骨窗开颅手术治疗不同血肿体积高血压性脑出血疗效分析

Analysis on effect of small bone flap craniotomy in treating different hematoma volumes of hypertensive cerebral hemorrhage

目的探讨小骨窗开颅手术治疗不同血肿体积高血压性脑出血的疗效。方法选取该院2013年5月至2016年5月收治的高血压性脑出血(基底节区,不含丘脑)患者100例,按血肿体积分为大剂量组(血肿体积30~<80 mL,61例)和小剂量组(血肿体积小于30 mL,39例)。100例患者均行小骨窗开颅手术。评估两组患者血肿清除程度、住院期间病死率、术后3个月日常生活能力等。结果大剂量组患者血肿完全清除率、术后3个月日常生活能力Ⅰ~Ⅲ比例明显低于小剂量组,住院期间病死率、日常生活能力Ⅳ~Ⅴ比例明显高于小剂量组,差异均有统计学意义(P<0.05)。结论小骨窗开颅手术治疗高血压性脑出血具有独特优势,在基底节区血肿体积80 mL范围内,血肿体积越小,小骨窗开颅手术效果越好,但在临床实际操作中要根据患者具体病情制定个体化手术方式。

Objective To investigate the efficacy of small bone flap craniotomy in the treatment of different hematoma volumes of hypertensive cerebral hemorrhage. Methods One hundred patients with hypertensive cerebral hemorrhage （basal ganglia,excluding thalamus） in our hospital from May 2013 to May 2016 were selected and divided into high volume group （hematoma volume 30-〈80 mL, 61 cases） and small volume group （hematoma volume 〈30 mL, 39 cases） according to hematoma volume. All cases underwent small bone flap craniotomy. The hematoma removal degree, mortality during hospitalization and daily living ability at postoperative 3 months were evaluated in the two groups. Results The complete clearance rate of hematoma, proportion of daily living ability Ⅰ-Ⅲ at postoperative 3 months in the high volume group were significantly lower than those in the small volume group, while the mortality during hospitalization, daily living ability Ⅳ-Ⅴ were significantly higher than those in the small volume group, the difference was statistically significant （P〈0.05）. Conclusion Small bone flap craniotomy for treating hypertensive cerebral hemorrhage has the unique advantages,within the range of hematoma volume 80 mL,the smaller the hematoma volume, the better the effect of small bone flap craniotomy treatment,but it is needed to formulate the individualized surgical mode in practical operating according to the patient＇s specific disease condition.