骨瓣开颅与微创手术治疗基底节区大出血量的高血压脑出血

Bone Craniotomy and Minimally Invasive Surgery for Hypertensive Cerebral Hemorrhage with Massive Hemorrhage in Basal Ganglia

目的:探讨骨瓣开颅血肿清除术与微创颅骨钻孔血肿穿刺置软管引流术治疗出血量大于60 mL的基底节区高血压脑出血患者临床治疗的近期和远期效果。方法:选取本院2012年3月-2017年3月期间收治的213例出血量大于60 mL的高血压脑出血患者,按照治疗方法不同分为观察组与对照组,其中观察组为105例微创手术治疗患者,对照组为108例骨瓣开颅治疗患者,对比两组患者手术时间指标,术后再出血,术后感染,术后神志恢复时间,术后并发症,住院时间,随访3个月～2年GOS预后评分及生活质量评分等。结果:(1)观察组患者手术时间、术中出血、术后神志恢复时间、住院时间、术后并发症等均小于对照组,比较差异均有统计学意义(P<0.05);(2)观察组术后感染发生率低于对照组,再出血率大于对照组,但两组比较差异均无统计学意义(P>0.05);(3)微创术后再出血9例转开颅,5例有脑疝形成迹象的转开颅,观察组GOS评分5分0例,4分43例,3分59例,2分1例,1分死亡2例;对照组术后再出血7例,硬膜下积液16例,脑梗死12例,术后颅内感染1例,对照组GOS评分:5分0例,4分29例,3分64例,2分6例,1分死亡9例;(4)观察组生活质量各维度评分均高于对照组,比较差异均有统计学意义(P<0.05)。结论:出血量大的高血压脑出血微创手术治疗较传统骨瓣开颅治疗方法,具有明显的微创治疗优势,患者术后恢复较快,治疗效果好且术后生活质量高,在满足适应证情况下可优先考虑微创手术治疗方法,微创手术后再出血、脑出血有脑疝形成或脑疝形成迹象的患者选择开颅治疗更有优势。

Objective:To investigate the short-term and long-term effects of bone flap craniotomy hematoma evacuation and minimally invasive skull drilling hematoma puncture and hose drainage for the treatment of patients with hypertensive cerebral hemorrhage in basal ganglia with a bleeding volume greater than 60 mL.Method:The subjects of the study were 213 patients of hypertensive cerebral hemorrhage with a hemorrhage of more than 60 mL admitted to our hospital from March 2012 to March 2017.They were divided into observation group of 105 cases and control group of 108 cases according to the treatment methods,the observation group was given minimally invasive surgery,the control group was given bone flap craniotomy hematoma evacuation,the operation time index,postoperative rebleeding,postoperative infection,postoperative recovery time,postoperative complications, hospitalization time,follow-up 3 months to 2 years of GOS prognosis score and quality of life score of two groups were compared.Result:(1)The operation time, intraoperative hemorrhage, postoperative recovery time, hospitalization time and postoperative complications in the observation group were lower than those of the control group,the differences were statistically significant(P<0.05).The incidence of postoperative infection in the observation group was lower than that of the control group,the rate of rebleeding in the observation group was greater than that in the control group,the differences were not statistically significant(P>0.05).(3)In the observation group,9 cases of rebleeding after minimally invasive surgery were converted to craniotomy,5 cases had cerebral palsy with signs of cerebral palsy,the GOS score of 5 points in 0,4 points in 43 cases,3 points in 59 cases,2 points in 1 case, and 1 point in 2 cases.In the control group,there were 7 cases of hemorrhage,16 cases of subdural effusion,12 cases of cerebral infarction, 1 case of postoperative intracranial infection,the GOS score of 5 points in 0, 4 points in 29 cases, 3 points in 64 cases, 2 points in 6 cases, 1 point in 9 patients died.(4)The scores of life quality in the observation group were higher than those in the control group,the differences were statistically significant(P<0.05).Conclusion:Minimally invasive surgery for hypertensive cerebral hemorrhage with large amount of bleeding has obvious advantages in minimally invasive treatment compared with traditional craniotomy.The patients’ recovers quickly,the treatment effect is good and the postoperative quality of life is high.In the case of indications,minimally invasive surgery can be given priority.Patients with recurrent hemorrhage after minimally invasive surgery,cerebral hemorrhage with cerebral palsy or signs of cerebral palsy are more likely to choose craniotomy.