高血压丘脑出血的手术治疗

目的探讨高血压丘脑出血患者手术治疗的效果。方法高血压丘脑出血的患者58例,10例丘脑小血肿(10~30 m)l且有单侧或双侧脑室铸型者行脑室外引流及尿激酶纤溶治疗、17例丘脑出血未破入脑室且出血量31~40 ml者立体定向血肿穿刺碎吸术治疗,15例丘脑出血破入脑室且血肿量较大(>40 ml)者行血肿穿刺联合脑室外引流治疗及16例血肿量大且基本位于中心部位并破入脑室者经纵裂入路显微镜下丘脑血肿清除术治疗。结果术后6个月存活49例,死亡9例。存活者术后6个月按日常生活能力分级评估预后:1级15例,2级19例,3级10例,4级5例。结论高血压丘脑出血患者应根据出血量、有无破入脑室及其病情制定手术方案,经纵裂入路显微镜下丘脑血肿清除术对出血位于中线丘脑且出血量较大者有其可行性。

Individualized surgical treatment of hypertensive thalamic hemorrhage (report of 58 cases)

Objective To explore the curative effect of individualized surgical treatment on hypertensive thalamic hemorrhage.Methods Of 58 patients with hypertensive thalamic hemorrhage,10 who had small thalamic hematomas(10~30 ml) and intraventricular hematomas were treated by extraventricular drainage and thrombolysis with urokinase,17 who had only 31~40 ml thalamic hematomas were treated by the stereotactic puncture,smash and drainage of the hematomas,15 who had relatively big thalamic hematomas and intraventricular hematomas by the puncture and aspiration of hematomas and extraventicular drainage,and 16 who had big hematomas(> 40 ml) in the thalamic centers and intraventricular hematomas were treated by microsurgery through interhemispheric fissure approach.Results Of 58 patients,9 died and 49 survived.According to activity of daily living(ADL),of 49 survivors,15 belonged in ADL grade 1,19 in grade 2,10 in grade 3 and 5 in grade 4.Conclusions The patients with hypertensive thalamic hemorrhage should be treated by the individualized surgery according to the hematoma volume and region(whether there was hematoma in the cerebral ventricle?) and patients’conditions.The removal of the thalamic hematomas nearby the mid line by microsurgery through the interhemiaspheric fissure is feasible in the patients with hypertensive thalamic hemorrhage