小骨窗联合颅内压监护治疗脑出血破入脑室的疗效分析

Microsurgery through small skull window and placement of intracranial pressure sensor into temporal horn of lateral ventricle in management of hypertensive basal ganglia hemorrhage broken into the ventricles

目的比较传统大骨瓣开颅血肿清除术和小骨窗开颅显微血肿清除联合侧脑室颞角颅内压传感器植入引流术治疗破入脑室高血压基底节区出血的疗效。方法回顾2015年3月~2016年3月共收治破入脑室的基底节区出血患者58例,将其分为传统大骨瓣血肿清除术组和小骨窗显微血肿清除联合侧脑室颞角颅内压传感器植入引流术组,其中传统大骨瓣血肿清除组30例,小骨窗显微血肿清除联合侧脑室颞角颅内压传感器植入引流术组28例,术后随访3个月~1年,观察两组患者的血肿清除率、骨瓣去除率、死亡率、日常生活能力(ADL)良好率和脑积水发生率。结果大骨瓣血肿清除术组血肿清除率、骨瓣去除率、死亡率、ADL良好率和脑积水发生率分别为90%(27/30)、40%(12/30)、3.3%(1/30)、66.7%(20/30)和10%(3/30),小骨窗显微血肿清除联合侧脑室颞角颅内压传感器植入引流术组血肿清除率、骨瓣去除率、死亡率、ADL良好率和脑积水发生率分别为89.3%(25/28)、0%(0/28)、3.5%(1/28)、71.4%(20/28)、0%(0/28),骨瓣去除率和脑积水发生率在两组之间有统计学意义(P<0.05)。结论小骨窗显微血肿清除联合侧脑室颞角颅内压传感器植入引流术治疗高血压基底节脑出血破入脑室的患者,是一种安全、有效且并发症少的治疗方式。

Objective Comparison study of large craniotomy and microsurgery through small skull window and placement of intracranial pressure sensor into temporal horn of lateral ventricle in management of hypertensive basal ganglia hemorrhage broken into the ventricles. Methods A total of 58 patients with hypertensive basal ganglia hemorrhage broken into the ven- tricles treated by operation from March 2015 to March 2016 were analyzed retrospectively, 30 pa- tients in large craniotomy group and 28 patients in microsurgery group through small skull win- dow and placement of intracranial pressure sensor into temporal horn of lateral ventricle. All pa- tients were followed up for 3 months^l years, two groups were estimated by clearance rate of he- matoma, removal rate of bone flap,mortality, ADL scores and the incidence of hydrocephalus. Re- suits Clearance rate of hematoma,removal rate of bone flap,mortality,the good prognosis rate of ADL and the incidence of hydrocephalus is respectively 90% （27/30）, 40% （12/30）, 3. 3 % （1/30）, 66.7% （20/30）and 10% （3/30）in large craniotomy group. Clearance rate of hematoma, removal rate of bone flap,mortality,the good prognosis rate of ADL and incidence of hydrocephalus is re- spectively 89.3%（25/28） ,0% （0/28）, 3. 5% （1/28）, 71.4% （20/28）, 0% （0/28） in mierosurgery group through small skull window and placement of intracranial pressure sensor into temporal horn of lateral ventricle. The removal rate of bone flap and the incidence of hydrocephalus is sta- tistically significant between the two groups（P〈0. 05）. Conclusion microsurgery through smallskull window and placement of intracranial pressure sensor into temporal horn of lateral ventricle in management of hypertensive basal ganglia henlorrhage broken into the ventricles is a safe, ef- fective and less compiication of treatment measure.