超早期小骨窗外侧裂入路显微手术治疗高血压基底节脑出血  

Ultra-early microsurgical treatment via small bone flap craniotomy through Transsylvian fissure approach for hypertensive basal ganglia hemorrhage

作　　者：张建军[1] 

机构地区：[1]山东省临清市泰山医学院附属聊城市第二人民医院神经外科,252601

出　　处：《中国临床实用医学》2008年第8期40-42,共3页China Clinical Practical Medicine

摘　　要：目的探讨超早期小骨窗外侧裂入路显微手术治疗高血压性基底节脑出血效果。方法回顾分析2000年1月至2007年12月间小骨窗经外侧裂入路显微手术治疗108例高血压性基底节脑出血的临床资料。结果术后24h意识状况：60例神志清楚，18例较术前好转，30例无明显改善。24内复查CT，血肿完全清除30例，75％以上有36例，50％～75％者有22例，50％以下10例，再出血10例；再次手术8例；死亡18例，死亡率达16．67％；术后2周复查CT存活90例患者血肿、脑水肿均消失；术后随访6个月，按ADL分级进行测评：Ⅰ级14例（12．96％）；Ⅱ级20例（18．52％）；Ⅲ级40例（37．04％）；Ⅳ级10例（9．25％）；V级6例（5．56％）。结论超早期小骨窗外侧裂入路显微手术治疗高血压性基底节脑出血，创伤小，清除血肿彻底，并发症和致残率低，一种有效的微创治疗方法；但不适于脑疝以及大量血肿和严重颅高压者。Objective To explore the clinical effects of Ultra-early microsurgical treatment via small bone flap craniotomy through Transsylvian fissure for hypertensive basal ganglia hemorrhage. Methods Analysis was retrospectively performed in 108 cases with hypertensive basal ganglia hemorrhage which were treated by Uhra-early microsurgery via small bone flap craniotomy through Transsylvian fissure approach in our department from 2001.1 to 2007. 12. Results Within 24 hours after operation, all patients were observed on consciousness state. Consciousness in 60 cases, improving of consciousness in 18 cases,inefficient in 30 cases. Postoperative CT re-examination within 24 hours showed the hematoma total clearance in 30 cases, more than 75 % in the primary size in 36 cases,50% -75% in 22 cases, less than 50% in 10 cases, recurrence of hematoma in 10 cases. Reoperations were performed in 8 cases. Among them 18 cases were dead,the mortality was 16. 67%. CT re-examination 2 weeks postoperatively showed the hematoma thorough clearance in 90 cases survived. Follow-up assessment according to the Glasgow Outcome Scale （ GOS ） for 6 months showed 14 cases for Grade Ⅰ （ 12. 96% ）, 20 cases for ⅡGrade （ 18.52% ）, 40 cases for Grade Ⅲ（ 37. 04% ）, 10 cases for Grade Ⅳ（9.25%） ,6 cases for GradeV （5.56%）. Conclusion Ultra-early microsurgical treatment via small bone flap craniotomy through Transsylvian fissure approach for hypertensive basal ganglia hemorrhage is an effective thera- peutic method which has the advantages of little invasion, thorough removal of lesion, low incidence of complications and disability, and fast functional recovery. But it is not suitable for patients with cerebral hernia, a large amount of hematoma and very high intracranial pressure.

关 键 词：高血压脑出血 基底节 超早期 小骨窗 经外侧裂入路 显微手术 

分 类 号：R651.1[医药卫生—外科学]