原发性基底节区脑出血手术策略的选择及疗效分析  

The surgical strategy and outcome of primary intracerebral hemorrhage in basal ganglia

作　　者：李峰[1] 周良东[1] 陈琳[1] 夏连贵[1] 

机构地区：[1]安徽省池州市人民医院神经外科,池州247000

出　　处：《立体定向和功能性神经外科杂志》2013年第5期297-300,共4页Chinese Journal of Stereotactic and Functional Neurosurgery

摘　　要：目的探讨原发性基底节区脑出血手术策略的选择并对其疗效进行分析总结。方法2008年1月至2013年1月经手术治疗原发性基底节区脑出血病人120例。对于血肿量在30-60ml或者血肿量较大已形成脑疝者87例患者行开颅手术血肿清除术，其中未脑疝并且一般身体情况较好的56例行微创小骨窗经侧裂-岛叶入路血肿清除术；另31例血肿量较大已形成脑疝者行大骨瓣颅血肿清除术，12例由于术后脑压仍高加行去骨瓣减压术。对于合并有心，脑，肾严重疾病，以及年龄大于70岁的33例病人行血肿穿刺引流术。术后3天复查头颅CT，观察血肿清情况，术后半年按照COS量表对患者进行疗效评定。结果采用血肿穿刺引流术33例患者术后3天，再出血4例，术后6个月GOS预后评分5分0例，4分16例，3分100例，2分4例，1分3例；采用开颅血肿清除术87例患者，其中56例采用小骨窗经侧裂-岛叶入路，术后3天再出血4例，术后6个月COS预后评分5分0例，4分38例，3分14例，2分2例，1分2例；而行大骨瓣颅内清除31例患者，术后3天再出血8例，术后6个月GOS预后评分5分0例，4分11例，3分9例，2分6例，1分5例。结论对于血肿量在30-60ml，未脑疝并且一般身体情况较好的患者，行小骨窗经侧裂-岛叶入路血肿清除术，手术效果好，恢复快；对血肿量大于60ml或者脑疝的病人，建议行大骨瓣颅血肿清除术，必要时行去骨瓣减压术。合并有心，脑，肾严重疾病，以及年龄大于70岁的病人行血肿穿刺引流术。早期进行小骨窗开颅血肿清除术及积极处理并发症有助于降低基底节区脑出血患者的死亡率，改善其预后。Objective To analyze the surgical strategy and outcome of primary intracerebral hemorrhage in basal ganglia. Methods The clinical date of 120 patients with primary intracerebral hemorrhage in Basal ganglion region who underwent surgical management from January 2008 to January 2013 were collected. Of 87 patients with hematoma volume in 30-60 ml or hematoma volume larger who in the dying situation which manifested with cerebral hernia were treated by craniotomy and hematoma evacuation. Among them, 56 patients who had better situation and without cerebral hernia were performed hematoma evacuation transsylvian--transinsular approaches. Another 31 cases with huge basal ganglia hemorrhage were treated by hematoma e- vacuation through conventional craniotomy approach, 12 cases were pulsed decompressive crani- ectomy due to intracranial hypertension after hematoma evacuation. 33 patients aged older than 70 or suffered serious diseases were treated by drainage of the hematomas. Cranial CT was reex- amined three days later to define Hematoma disappearance and favorable Outcome were compared according to the GOS scales half a year later. Results CT scans at day 3 postoperation revealed that the recurrent hemorrhage was 4 cases in 33 patients and the GOS at half a year postoperation was 5 points 0 cases, 4 points 16 cases, 3 points 10 cases, 2 points 4 cases, 1 points 3 cases which were treated by drainage of the hematomas. Meanwhile, there were 4 cases of recurrent hemorrhage in 56 patients which were performed hematoma evacuation through transsylvian--transinsular approaches compared to 8 cases of recurrent hemorrhage in 31 patients which were treated by hematoma evacuation through conventional craniotomy approach. Respectively, the GOS at half a year postoperation was 5 points 0, 4 points 38 cases, 3 points 14 cases, 2 points 2 cases, 1 points 2 cases and 5 points 0, 4 points 11 cases, 3 points 9 cases,2 points 6 cases, 1 points 5 cases. Con- clusion The patients with hematoma volume in 30-60 ml and without cerebral herni

关 键 词：高血压病 脑出血 手术治疗 疗效 

分 类 号：R743.34[医药卫生—神经病学与精神病学]