无牵开外科手术治疗基底节区高血压脑出血  

The clinical application of retractorless surgery in patients with hypertensive basal ganglia hemorrhage

作　　者：赵朝辉[1] 钟兴明[1] 汪一棋[1] 阳建国[1] 蔡勇[1] 费振海 张磊[1] 

机构地区：[1]浙江省湖州师范学院附属第一医院,浙江省湖州市第一人民医院神经外科,313000

出　　处：《中华医学杂志》2017年第9期666-669,共4页National Medical Journal of China

摘　　要：目的总结分析无牵开外科手术治疗基底节区高血压脑出血的临床应用经验。方法收集2014年6月至2016年6月在浙江省湖州市第一人民医院行无牵开外科手术治疗的基底节区高血压脑出血患者84例，其中男53例，女31例。年龄29～74岁，平均58.7岁。入院格拉斯哥昏迷（GCS）评分4～5分10例（包含瞳孔散大3例），6～8分25例，9～12分32例，13～14分17例。出血量在30～100 ml，平均50.2 ml。回顾性分析患者术后日常生活能力（ADL）以及手术相关并发症。结果84例基底节区高血压脑出血患者中，血肿清除〉90%76例（90.5%），术后再出血6例（7.1%），均无需2次手术，脑梗死2例（2.4%）、皮下积液伴感染7例（8.3%）。术后随访58例，恢复良好85.3%。结论熟练掌握规范的显微神经外科技术，采用无牵开外科手术治疗基底节区高血压脑出血可以降低术后脑梗死等相关并发症。Objective To discuss the clinical feasibility and practical application of retractorless surgical for patients with hypertensive basal ganglia hemorrhage.Methods A total of 84 patients underwentretractorless surgery in The First People′s Hospital of Huzhou from Jun 2014 to Jun 2016 were retrospectively reviewed.There were 53 male and 31 female of the 84 patients. Their mean age were 58.7 years with range： 29-74 years.Glasgow coma scale score（GCS） at admissionwereas follow： GCS 4-5 points 10 cases（including 3 cases companied dilated pupils）, GCS 6-8 points 25 cases, GCS 9-12 points 32 cases, and GCS 13-14 points 17 cases.The average volume of hematoma was 50.2 （30-100） mL.Complications related tosurgery and postoperative activities of daily living （ADL） scorewere analyzed.Results 0f the 84 cases, there were 76 （90.5%） patientswhose intracranial hematoma were removed more than 90%. Postoperative bleeding was occurred in 6 cases （7.1%）, all without secondary surgery. Cerebral infarctionwas occurred in 2 cases （2.4%）, subcutaneous effusion associated with infectionwas occurred in 7 cases （8.3%）. Postoperative follow-up of 58 cases, 85.3% recovered well.Conclusions With the proficiency in microneurosurgery methods, retractorless surgery couldreduce the related postoperative complications, such as postoperative cerebral infarction.

关 键 词：牵开器手术 手术并发症 颅内出血 高血压性 

分 类 号：R651.12[医药卫生—外科学]