三种手术方式救治基底节区高血压性脑出血148例的近期疗效分析  

Analysis on recent curative effect of 148 patients with hypertensive cerebral hemorrhage in basal ganglia treated by three surgical methods

作　　者：李梅 汤进伟 李丰 陈晓鹏 彭艳红 王家雄 LI Mei;TANG Jinwei;LI Feng;CHEN Xiaopeng;PENG Yanhong;WANG Jiaxiong(Department of Neurosurgery,Southern Central Hospital of Yunnan Province/First People's Hospital of Honghe Prefecture,Honghe Yunnan 661100,China;Comprehensive Ward,Southern Central Hospital of Yunnan Province/First People's Hospital of Honghe Prefecture,Honghe Yunnan 661100,China;Dali University,Dali Yunan 671003,China)

机构地区：[1]云南省滇南中心医院/红河州第一人民医院神经外科,云南蒙自661100 [2]云南省滇南中心医院/红河州第一人民医院综合病区,云南蒙自661100 [3]大理大学,云南大理671003

出　　处：《云南医药》2023年第6期31-35,共5页Medicine and Pharmacy of Yunnan

基　　金：云南省滇南中心医院(红河州第一人民医院)2020年度院级科研项目(KY202004)。

摘　　要：目的 比较三种手术方式治疗基底节区脑出血的优缺点。方法 回顾分析148例基底节区脑出血患者,其中穿刺组43例,小骨窗组30例,大骨瓣组75例,比较3组患者的一般资料、影像数据及疗效指标。结果 术前血肿量穿刺组小于各开颅组,中线偏移程度穿刺组小于大骨瓣组,有统计学差异(P<0.05)。其余术前指标无统计学差异(P>0.05)。手术时长和术中失血量小骨窗组优于大骨瓣组,术后残余血肿量穿刺组较各开颅组多,有显著统计学差异(P<0.001)。术后中线偏移程度、围术期死亡率、非计划二次手术率、平均住院日、出院时Mrs评分和GCS评分,3组间均无统计学差异(P>0.05)。结论 在基底节区脑出血的治疗中,小骨窗与大骨瓣开颅术疗效无差异,小骨窗开颅可作为穿刺术和内镜术的补救、保障技术。Objective To compare the advantages and disadvantages of by three surgical methods in treatment of hypertensive cerebral hemorrhage in basal ganglia.Methods A total of 148 patients who were diagnosed with hypertensive cerebral hemorrhage in basal ganglia were retrospectively analyzed.Among them,there were 43 patients in puncture group,30 patients in small bone window craniotomy group,and 75 patients in large bone flap craniotomy group.The general data,imaging data and efficacy indexes of the three groups were compared.Results The preoperative hematoma volume puncture group was smaller than each craniotomy group,and the midline deviation puncture group was smaller than the large bone flap group,with statistical differences(P<0.05).There was no statistical difference in other preoperative indexes(P>0.05).Operation duration and intraoperative blood loss in the small bone window group were less than those in the large bone flap group,and the volume of postoperative residual hematoma in the puncture group was more than those in each craniotomy group,with statistically significant difference(P<0.001).There were no statistical differences among the three groups in degree of postoperative midline deviation,perioperative mortality,unplanned reoperation rate,average hospital stay,Mrs and GCS scores at discharge(P>0.05).Conclusions In the treatment of basal ganglia hypertensive intracerebral hemorrhage,there is no difference between small bone window craniotomy and large bone flap craniotomy.Small bone window craniotomy can also be used as a rescue and guarantee technique for puncture and endoscopic hematoma evacuation.

关 键 词：高血压脑出血 血肿清除术 微创穿刺 小骨窗 大骨瓣 

分 类 号：R651.12[医药卫生—外科学]