高血压脑出血的外科治疗进展

The Progress of Surgical Treatment of Hypertensive Cerebral Hemorrhage

高血压脑出血是所有脑卒中亚型中最严重的一种,占所有卒中的23.8%,具有很高的致死率和致残率,其预后与出血部位、出血量、出血速度、手术时机、手术方式、年龄、是否口服抗凝药物等因素密切相关。在严格掌握手术适应证和手术时机的前提下,微创手术(Minimal Invasive Surgery,MIS)包括神经内镜血肿清除术和立体定向碎吸加尿激酶溶解术,其与开颅显微血肿清除手术相比较已经显示出了更加微创、疗效更好的趋势。近年来,在我国内镜血肿清除手术开始普遍开展,哪种手术方式是最佳的治疗方法,需要临床多中心前瞻性随机对照实验来回答。现在有一项比较3种手术方式效果的随机对照实验《幕上高血压脑出血微创手术与开颅手术多中心、随机对照试验》(Minimally-invasive Surgery Versus Craniotomy in Patients With Supratentorial Hypertensive Intracerebral Hemorrhage(MISICH))正在我国多个临床中心进行。

Intracerebral hemorrhage(ICH)is a subtype of stroke with high morbidity and mortality,accounting for23.8%in all srokes.The prognosis of ICH is closely related with the location,volume and speed of hemorrhage,timing of surgery,surgical procedure,age,administration of oral anticoagulants and other factors.Under the strict control of surgical indications and timing of surgery,minimally invasive surgery(MIS)including endoscopic hematoma evacuation and stereotactic aspiration and urokinase surgery,has shown more minimally invasive and produced good neurological outcomes.In recent years,endoscopic hematoma evacuation has being widely carried out in Chinaand which one is the best among the three surgical procesures,RCT can answer it.Now there is a RCT to investigate it.It is MISICH(Minimally-invasive Surgery Versus Craniotomy in Patients With Supratentorial Hypertensive Intracerebral Hemorrhage):Comparison of three kinds of surgical procedures of a multi-center clinical trial,and it is in research in several clinic centers in China now.