壳核脑出血应用显微镜辅助微创小骨窗法清除血肿疗效分析  

Therapeutic effect of microscopy-assisted minimally invasive small bone window in clearing hematoma

作　　者：张鹏[1] 孙季威 张少军[1] ZHANG Peng;SUN Jiwei;ZHANG Shaojun(The first affiliated hospital of BengBu Medical University, Department of Neurosurgery, Bengbu 233000,China)

机构地区：[1]蚌埠医学院第一附属医院神经外科,安徽蚌埠233000

出　　处：《包头医学院学报》2020年第6期17-19,61,共4页Journal of Baotou Medical College

摘　　要：目的:分析高血压壳核脑出血(尚未出现脑疝)的患者应用传统大骨窗开颅与微创小骨窗法清除血肿疗效及预后差异。方法:选取蚌埠医学院第一附属医院神经外科自2018年9月至2019年10月收入治疗的87例壳核脑出血患者分为对照组和研究组,研究组应用微创小骨窗法清除血肿,对照组采取传统的去大骨瓣开颅手术,对两组进行比较分析。结果:87例患者均有效清除血肿,术后24小时内复查头颅CT无明显残留,在术后6个月GOS评分及死亡率上,两组差异不明显[传统开颅对照组死亡7例(16.3%),小骨窗组死亡4例(9.1%),P=0.493];术前术后GCS评分变化微创小骨窗组更占优势(P=0.017),在术前GCS评分较高的患者中[研究组19例(79%)预后良好,与对照组10例(50%)相比,P=0.042],应用小骨窗法术改善比对照组明显;对于术后颅内感染、脑脊液动力学障碍等并发症的总体发生率研究组明显低于对照组(P<0.01)。结论:微创小骨窗法与传统开颅相比,手术创伤相对较小,术后近期并发症发生率低,对于尚未出现脑疝的壳核脑出血患者更具优势。Objective:To analyze the efficacy and prognosis of patients with hypertensive cerebral hemorrhage(without cerebral palsy)using traditional large bone window craniotomy and minimally invasive small bone window to remove hematoma.Methods:Eighty-seven patients with cranial cerebral hemorrhage who were treated with neurosurgery from the First Affiliated Hospital of Bengbu Medical College from September 2018 to October 2019 were enrolled.The control group and the study group were compared.Results:All 87 patients were able to remove hematoma effectively.There was no significant residual CT scan within 24 hours after operation.There was no significant difference in GOS score and mortality between the two groups at the 6-month postoperative rate.[The traditional craniotomy control group died in 7 cases(16.3)%),4 cases(9.1%)died in the small bone window group,P=0.493];the preoperative and postoperative GCS scores were more dominant in the minimally invasive small bone window group(P=0.017),in patients with higher preoperative GCS scores.[The study group 19 patients(79%)had a good prognosis,compared with 10 patients(50%)in the control group,P=0.042],the use of small bone window spell improvement was more obvious than the control group;for postoperative intracranial infection,cerebrospinal fluid dynamics disorder The overall incidence of complications was significantly lower in the study group than in the control group(P<0.01).Conclusion:The minimally invasive small bone window method has a relatively small surgical trauma compared with the traditional craniotomy,and the incidence of recent complications is low.Patients with cerebral cerebral hemorrhage without cerebral palsy have an advantage.

关 键 词：高血压壳核脑出血 大骨瓣开颅术 微创小骨窗血肿清除术 

分 类 号：R65[医药卫生—外科学]