动态微牵拉和顺序血肿清除术在高血压脑出血手术中的应用

Application of Dynamic Retractorless Surgery and Sequential Evacuation of Hematomas in the Treatment of Hypertensive Intracerebral Hemorrhage

目的:探讨动态微牵拉和顺序血肿清除技术在高血压脑出血手术中应用的可行性及有效性。方法:前瞻性纳入2014年3月-2016年9月在漳州市第三医院神经外科收治的59例高血压脑出血的患者,随机分为观察组(n=31)和对照组(n=28)。观察组用吸引器和双极电凝动态微牵拉以及顺序血肿清除术,对照组用脑压板固定牵拉和常规血肿清除术。比较两种术式的血肿基本清除程度、术中责任出血动脉完全止血率、术后再出血发生率、脑牵拉相关损伤及术后6个月日常生活活动能力(ADL)的良好率。结果:观察组的血肿基本清除概率、术中责任出血动脉完全止血率、术后6个月日常生活活动能力(ADL)的良好率均高于对照组,差异均有统计学意义(P<0.05);观察组的术后再出血率、脑牵拉相关损伤发生率均低于对照组,手术时间短于对照组,差异均有统计学意义(P<0.05)。结论:动态微牵拉和顺序血肿清除技术在高血压脑出血手术中运用,能提供充分的动态手术空间、精准止血、彻底清除血肿、缩短手术时间、有效地避免牵拉脑损伤、有效地提高预后,是一种可行的和具有优越性的手术方法。

Objective： To investigate the feasibility and effectiveness of the dynamic retractorless surgery and sequential evacuation of hematomas in the treatment of hypertensive intracerebral hemorrhage.Method： A totalof 59 patients with hypertensive intracerebral hemorrhage in department of Neurosurgery of the Third Hospital of Zhangzhou from March 2014 to September 2016 were enrolled, the patients were randomly divided into observation group （ n=31 ） and control group （ n=28 ） .The observation group was given the sequential evacuation of hematomas through the dynamic retraction technology without fixed retractors, the control group was given the conventional evacuation of hematomas with a fixed brain retractor.The following indicators of hematoma clearance, hemostasis of responsible vessels, postoperative rebleeding, brain injury associated with traction, and the ability of activities of daily living （ ADL ） after 6 months of operation were compared between the two groups.Result： The clearance rate of hematoma, the hemostatic rate of responsible vessels, and the ability of activities of daily living （ ADL ） after 6 months of operation in the observation group were significantly higher than those in control gronp, the differences were statistically significant （ P〈0.05 ） .The postoperative rebleeding rate, the brain injury associated with traction and the operation time in observation group were significantly lower than those in control group, the differences were statistically significant （ P〈0.05 ） .Conclusion： The sequential evacuation of hematomas through the dynamic retraction without fixed retractors is a feasible surgical method in the treatment of hypertensive intracerebral hemorrhage, this technology has the advantages of plenty dynamic operation space, precise hemostasis, complete removal of hematoma, shorten operation time, mild brain injury associated with traction, and better prognosis, it is a feasible and superior operation method.