小骨窗开颅血肿清除术治疗高血压性基底节区出血  

Treatment of hypertensive basal ganglia hemorrhage by small bone window craniotomy

作　　者：王立江[1] 王久忠[1] 成立峰[1] 胡术珍 刘杰[2] 张响[2] 韩光良[1] 牟立坤[1] WANG Li-jiang WANG Jiu-zhong CHENG Li-feng HU Shu-zhen LIU Jie ZHANG Xiang HAN Guang-liang MU Li-kun(Department of Neurosurgery, Shengli Oilfield Central Hospital, Dongying 257034, China Department of Critical Care Medicine, Shengli OiIfield Central Hospital, Dongying 257034, China)

机构地区：[1]胜利油田中心医院神经外科,山东东营257034 [2]胜利油田中心医院重症医学科,山东东营257034

出　　处：《中国临床神经外科杂志》2017年第2期83-85,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨小骨窗开颅血肿清除术治疗高血压性基底节区出血的短期疗效及其影响因素。方法回顾性分析2012年6月至2015年12月收治的159例高血压性基底节区出血的临床资料,采用小骨窗开颅血肿清除术治疗62例(小骨窗开颅组),采用骨瓣开颅血肿清除术治疗97例(骨瓣开颅组);术后6个月采用改良Rankin量表(m RS)评分评估短期疗效。结果术后1~2 d复查CT示,两组脑内血肿清除率无明显差异(P>0.05)。两组术后颅内感染发生率、住院期间病死率、术后6月m RS评分等差异均无统计学意义(P>0.05),但小骨窗开颅组术后6个月癫痫发生率(12.90%)明显低于骨瓣开颅组(26.80%;P<0.05)。血肿量大和脑疝是小骨窗开颅手术预后的独立危险因素,而出血后12 h内手术对患者预后有益。结论对于高血压性基底节区出血,小骨窗开颅较骨瓣开颅可显著减少术后6个月癫痫发生率,手术时机、血肿量和脑疝显著影响患者短期预后。Objective To explore the short-term curative effect of small bone window craniotomy on hypertensive basal ganglia hemorrhage （BGH）. Methods Of 159 patients of hypertensive BGH, 62 （observed group） underwent small bone window craniotomy for intracerebral hematomas and 97 （control group） bone flap craniotomy from June, 2012 to December, 2015. Their clinical data were analyzed, including age, gender, preoperative GCS score, hematoma volume, herniation status, acute hydrocephalus status and opportunity of surgery. The curative effects and postoperative complication were compared between both the groupsl The factors related to the prognoses in the patients with hypertensive BGH undergoing small window craniotomy were analyzed. Results There were insignificant differences in the rates of clearance of intracerebral hematoma and intracranial infection, in-hospital mortality rate and modified Rankin Scale scores 6 months after the operation between the two groups （P〉0.05）, but the rate （26.8%, 26/97） of occurrence of epilepsy 6 months after the operation was significantly higher in the control group than that （12.9%, 8/62） in the observed group. The logistic multivariate analysis showed that the independent risk factor related to modified Rankin Scale Score 6 months after the operation included the large volume of hematoma and herniation in the patients with hypertensive BGH undergoing small bone craniotomy and surgery within 12 hours after intracerebral hemorrhage was beneficial to the improvement of the prognosis. Conclusions The small bone window craniotomy for hematomas is helpful to the decrease in the rate of epilepsy seizure 6 months after the operation in the patients with hypertensive BGH, in whom the prognoses may be improved by positive prevention of herniation and early （within 12 hours aftar the hemorrhage） surgery. Generally speaking, the prognosis is poor in the patients with large volume of hematoma after hypertensive BGH.

关 键 词：高血压性基底节区出血 小骨窗 血肿清除术 癫痫 

分 类 号：R743.34[医药卫生—神经病学与精神病学] R651.12[医药卫生—临床医学]