小骨窗微创手术用于治疗老年高血压性脑出血合并脑疝的疗效及其安全性  

Efficacy and safety of minimally invasive surgery with small bone window in the treatment of senile hypertensive intracerebral hemorrhage complicated with cerebral herniation

作　　者：夏恒 石磊 XIA Heng;SHI Lei(Department of Neurosurgery Integrated,Traditional Chinese and Western Medicine Hospital of Chuzhou,Chuzhou 239000,China;Department of Neurosurgery,the First People’s Hospital of Kunshan,Suzhou 215300,China)

机构地区：[1]滁州市中西医结合医院神经外科,安徽省滁州市239000 [2]昆山市第一人民医院神经外科,江苏省苏州市215300

出　　处：《实用老年医学》2023年第5期487-490,共4页Practical Geriatrics

摘　　要：目的比较老年高血压性脑出血合并脑疝病人实施小骨窗微创手术与传统大骨瓣开颅手术治疗的临床疗效及其安全性之间的差异。方法回顾性分析76例老年高血压性脑出血合并脑疝手术病人的临床资料,按照手术方式分为小骨窗组和大骨瓣组,前者36例行小骨窗血肿清除术,后者40例行大骨瓣减压术。比较2组术后24 h内血肿清除率、瞳孔恢复率、脑疝恢复率和格拉斯哥昏迷评分法(GCS)评分;比较2组手术时间、手术切口长度、术中出血量及近远期临床疗效;统计2组术后2周并发症发生情况。结果2组术后24 h内瞳孔恢复率、脑疝恢复率和GCS评分差异无统计学意义(P>0.05),但小骨窗组的血肿清除率低于大骨瓣组(P<0.05)。小骨窗组病人的手术时间、手术切口长度显著短于大骨瓣组,术中出血量显著少于大骨瓣组,差异均有统计学意义(P<0.01)。术后2周,小骨窗组发生应激性溃疡发生率和切口愈合率均优于大骨瓣组(P<0.05或P<0.01),2组肺部感染发生率和再出血率差异无统计学意义(P>0.05)。小骨窗组近、远期预后良好率均优于大骨瓣组,分别为83.33%比62.50%、61.11%比35.00%,差异均有统计学意义(P<0.05)。结论小骨窗微创手术较大骨瓣开颅手术更适用于治疗老年高血压性脑出血合并脑疝的病人。Objective To compare the clinical efficacy and safety between minimally invasive surgery with small bone window and traditional large bone flap craniotomy in the elderly patients with hypertensive intracerebral hemorrhage complicated with cerebral herniation.Methods The clinical data of 76 elderly patients with hypertensive intracerebral hemorrhage complicated with brain herniation were retrospectively analyzed,and they were divided into the small bone window group(n=36,receiving minimally invasive surgery with small bone window)and the large bone flap group(n=40,receiving large bone flap craniotomy).The hematoma clearance rate,pupil recovery rate,brain hernia recovery rate and the score of Glasgow coma scale(GCS)within 24 hours after operation,operation time,length of incision,intraoperative blood loss,and short-term and long-term clinical effects of the two groups were compared.The incidence of complications 2 weeks after operation in both groups was recorded.Results There were no differences in pupil recovery rate,brain hernia recovery rate and the score of GCS within 24 hours after operation between the two groups(P>0.05).The hematoma clearance rate was lower,the operative time and intraoperative blood loss were less,and the length of incision was shorter in the small bone window group than those in the large bone flap group(P<0.05 or P<0.01).The incidence rates of stress ulcer and wound healing in the small bone window group were better than those in the large bone flap group 2 weeks after operation(P<0.05 or P<0.01).However,there were no differences in the incidence rates of pulmonary infection and rebleeding beween the two groups(P>0.05).The short-and long-term good rates in the small bone window group were better than those in the large bone flap group(all P<0.05).Conclusions Compared with large bone flap craniotomy,minimally invasive surgery with small bone window is more suitable for the treatment of the elderly patients with hypertensive intracerebral hemorrhage complicated with brain herniation.

关 键 词：脑出血 高血压 微创 脑疝 老年人 小骨窗 

分 类 号：R743.34[医药卫生—神经病学与精神病学]