翼点入路经侧裂血肿清除术联合去骨瓣减压术治疗高血压脑出血

Lateral Fissure Hematoma Removal via Pterional Approach Combined with Decompressive Craniectomy for Hypertensive Cerebral Hemorrhage

目的探讨翼点入路经侧裂血肿清除术联合去骨瓣减压术治疗高血压脑出血的效果。方法将105例高血压脑出血患者按照手术方式分为对照组52例和观察组53例。对照组给予小骨窗微创术,观察组给予翼点入路经侧裂血肿清除术联合去骨瓣减压术。比较2组手术效果、颅内压、神经功能及术后血肿再发率。结果2组手术时间、出血量对比差异无统计学意义(P>0.05)。观察组血肿清除率较对照组高,术后1、3 d颅内压水平较对照组低(P<0.05)。观察组术后GOS及BI评分较对照组高,NIHSS评分较对照组低(P<0.05)。术后随访3个月,观察组血肿再发率(1.89%)较对照组(11.54%)低(P<0.05)。结论翼点入路经侧裂血肿清除术联合去骨瓣减压术可通过有效清除高血压脑出血患者脑血肿,降低颅内压,改善神经功能及降低术后血肿再发率。

Objective To explore the effect of lateral fissure hematoma removal via pterional approach combined with decompressive craniectomy on hypertensive cerebral hemorrhage.Methods A total of 105 patients with hypertensive intracerebral hemorrhage were assigned to receive either small bone window microsurgery(control group,n=52)or lateral fissure hematoma removal via pterional approach combined with decompressive craniectomy(observation group,n=53).Surgical outcome,intracranial pressure,neurological function and recurrence rate of postoperative hematoma were compared between the two groups.Results There were no significant differences in operation time and bleeding volume between the two groups(P>0.05).Compared with the control group,the hematoma clearance rate and postoperative GOS and BI scores increased,and the intracranial pressure at 1 and 3 days after operation and postoperative NIHSS decreased in the observation group(P<0.05).After 3 months of follow-up,the recurrence rate of hematoma in the observation group(1.89%)was lower than that in the control group(11.54%)(P<0.05).Conclusion Lateral fissure hematoma removal via pterional approach combined with decompressive craniectomy can effectively remove hematoma,reduce intracranial pressure,improve nerve function and decrease recurrence of hematoma in patients with hypertensive intracerebral hemorrhage.