自发性脑出血破人脑室的显微手术治疗探讨

目的探讨自发性脑出血破入脑室的手术治疗方法。方法采取大骨瓣开颅显微镜下血肿清除术和小骨窗开颅显微镜下血肿清除术，对38例自发性脑出血破入脑室的患者行手术治疗。结果术后存活33例，死亡5倒（13％），随访存活患者，按ADL评分：Ⅱ级10例（26％），Ⅲ级15例（39％），Ⅳ级5例（13％），Ⅴ级3例（8％）。结论对早期自发性脑出血量〉30ml并发脑疝患者应尽早行大骨瓣开颅显微镜下血肿清除术，对于出血量〈30ml或形状不规则破入脑室应严密观察下行保守治疗〉24h后取小骨窗微创手术清除血肿，可降低死残率，提高生存质量。

MICROSURGERY TREATMENT ON SPONTANEOUS CEREBRAL HEMORRHAGE WITH INTRAVENTRICULAR HEMORRHAGE

Objective To approach the therapeutic effects of spontaneous intraventricular hemorrhage on microsurgery treatment. Methods 38 cases with spontaneous intraventricular hemorrhage were respectively treated by the large bone petal of minimally invasive surgery and the microsurgery with small incision operates under the microscope. Results 33 patients were alive, 5 cases dead (13%). According to ADL score, 10 cases were grade Ⅱ (26%), 15 cases were grade Ⅲ (39%), 5 cases were grade Ⅳ (130%) and 3 cases were grade Ⅴ (8 %). Conclusion Patients with early high volume cerebral hemorrhage(＞30ml) ,and herniation should be operated under the microscope as soon as possible. As for the amount of cerebral hemorrhage ＜30ml or irregular in shape broken into ventricles downlink, conservative rule should be carried out under close observation. After 24 hours, suitable small incision minimally invasive surgery should be performed to remove the hematoma, which may decrease mortality, reduce disablement rate and increase survival quality.