幕上脑出血手术方式的临床探讨  

Clinical study on surgical methods of supratentorial intracerebral hemorrhage

作　　者：林泽西 宝音图 丁煜昊 王剑刃[1] 谢涛 林荔青[1] 吴日乐 傅西安[1] Lin Zexi;Bao Yintu;Ding Yuhao;Wang Jianren;Xie Tao;Lin Liqing;Wu Rile;Fu Xi'an(Departiment of Neurosurgery,the Affiliated Suzhou Hospial of Nanjing Medical University,Suzhou 215008,China;Department of Neurosurgery,Inner Mongolia People's Hospital,Huhhot 010017,China)

机构地区：[1]南京医科大学附属苏州医院神经外科,苏州215008 [2]内蒙古自治区人民医院神经外科,呼和浩特010017

出　　处：《国际外科学杂志》2022年第8期544-548,F0004,共6页International Journal of Surgery

基　　金：苏州市临床重点病种诊疗技术专项基金资助项目(LCZX201913);内蒙古自治区自然科学基金项目(2020MS08108);内蒙古自治区科技计划项目(2021GG0114)。

摘　　要：目的探讨及分析幕上脑出血的手术方法的选择。方法采用回顾性病例分析方法, 纳入2017年1月至2021年12月南京医科大学附属苏州医院神经外科收治的幕上脑出血手术患者共260例作为研究对象。按照手术方式的不同分为大骨瓣组(n=116)、常规骨瓣组(n=89)和立体定向组(n=55)。大骨瓣组行幕上标准大骨瓣开颅手术, 常规骨瓣组行常规骨瓣开颅手术, 立体定向组行立体定向血肿穿刺抽吸+引流手术。统计三组患者手术时间、术中出血量、肺部感染、住院时间等临床指标及术后随访6个月时格拉斯哥预后评分(GOS), 并计算预后良好(GOS 4~5分)的比例。服从正态分布的计量资料以均数±标准差(x^(-)±s)表示;计数资料用例数和百分率(%)表示。结果大骨瓣组手术时间、术中出血量、住院时间、肺部感染、术后再出血分别为(193±24) min、(625±65) mL、(46±11) d、102例(87%)、9例(7.8%);常规骨瓣组分别为(124±17) min、(297±35) mL、(32±9) d、29例(33%)、4例(4.4%);立体定向组分别为(73±11) min、(53±15) mL、(21±4) d、10例(18%)、2例(3.6%)。所有患者术后随访6个月, 根据GOS评分, GOS 5分70例, 4分95例, 3分40例, 2分38例, 1分(死亡)17例, 预后良好的患者(GOS 4~5分)165例(63.5%), 其中大骨瓣组36例(31%), 常规骨瓣组82例(93.2%), 立体定向组47例(85.5%)。结论标准大骨瓣开颅术减压充分, 适用于严重威胁生命的血肿;常规骨瓣开颅术在继发性脑出血治疗中具有优势;立体定向具有手术时间短、术中出血量少、住院时间短、肺部感染发生率低等特点, 在原发性脑出血的治疗中值得推广。Objective To explore and analyze the selection of surgical methods for supratentorial intracerebral hemorrhage.MethodsA total of 260 patients with spontaneous intracerebral hemorhage who underwent surgery in Department of Neurosurgery,Suzhou Hospital Affiliated to Nanjing Medical University from January 2017 to December 2021 were included in the study by retrospective case analysis.According to different surgical methods,they were divided into three groups:large bone flap group(n=116),conventional bone flap group(n=89)and stereotactic group(n=55).The large bone flap group underwent standard supratentorial large bone flap craniotomy,the conventional bone flap group underwent conventional bone flap craniotomy,and the stereotactic group underwent stereotactic hematoma puncture suction+drainage.Clinical indicators such as operation time,intraoperative bleeding,pulmonary infection,length of hospital stay,and Glasgow outcome scale(GOS)at 6 months of postoperative follow-up,and the proportion of good prognosis(GOS 4-5)were calculated.Measurement data with normal distribution were expressed as meanx±standard deviation(x^(-)±s),count data were expressed as cases and percentages(%).Results In the large bone flap group,the operation time,intraoperative bleding,hospital stay,pulmonary infection,postoperative rebleeding were(193±24)min,(625±65)mL,(46±11)d,102 patients(87%),9 patients(7.8%),and(124±17)min,(297±35)mL,(32±9)d,29 patients(33%),4 patients(4.4%)in the conventional bone flap group,and(73±11)min,(53±15)mL,(21±4)d,10 patients(18%),2 patients(3.6%)in stereotactic group.All patients were folowed up for 6 months,and 165 patients(63.5%)had good prognosis(GOS 4-5),including 36 patients(31%)in the large bone flap group,82 patients(93.2%)in the conventional bone flap group,and 47 patients(85.5%)in the stereotactic group.Conclusion Standard large craniectomy has sufficient ffect of decompresion,and is suitable for serious life threatening hematoma;Conventional craniotomy has advantages in the treatment of secondary

关 键 词：脑出血 外科手术 选择性 格拉斯哥预后评分 骨瓣开颅 立体定向 

分 类 号：R651.12[医药卫生—外科学]