高血压性Ⅲ级脑出血早期外科手术方法探讨

目的比较大骨瓣开颅血肿清除并去骨瓣喊压和小骨窗开颅血肿清除两种术式早期治疗高血压性Ⅲ级脑出血的疗效。方法同期收住的121例高血压性Ⅲ级脑出血患者，78例行小骨窗开颅血肿清除（小骨窗组），43例行大骨瓣开颅血肿清除并去骨瓣减压（大骨瓣组），术后1个月和6个月分别行临床随访，综合比较其临床疗效、血肿清除率以及手术并发症。结果大骨瓣组在血肿清除程度、术后并发症发生率（除外消化道出血）、死亡率和1个月及6个月随访疗效等方面两组并无显著性差异．但在术后消化道出血发生率中却明显高于小骨窗组（P〈0．05），同时在手术时间和输血量等方面小骨窗组明显少于大骨瓣组（P〈0．01）。结论在高血压性Ⅲ级脑出血病人的早期手术治疗中，小骨窗开颅血肿清除术可作为首先考虑的手术方式。

Surgery at Early Stage for Hypertensive Cerebral Hemorrhage Of Ⅲ Degree

Objective To observe the curative effect of both the deeompressive large craniotomy combined with evacuation of the hematoma and craniotomy with small bone window for evacuation of the hematomas at early stage on tbypertensive cerebral hemorrhage of m degree. Methods Of 121 patients with hypertensive cerebral hemorrhage of Ⅲ degree, 78 were treated by eraniotomy with small bone window for evacuation of the hematomas and 43 by decompressive large craniotomy combined with evacuation of the hematomas at early stage after the hemorrhage. Following-up was performed 1 month and 6 months respectively after the operation. The curative effect, extent of evacuation of the hematomas and operative complications were compared between both the groups. Results There was insignificant difference in the extent of evacuation of the hematomas, operative complications （except stress ulcer）, mortality and prognosis between both the groups 1 month and 6 months after the operation. Compared with decompressive craniotomy group, the small bone window craniotomy group had significantly lower rate of the postoperative stress ulcer, shorter operative duration and less bleeding during the operation. Conclusion The craniotomy with small bone window for the evacuation of the hematoma should be first selected for the treatment of hypertensive cerebral hemorrhage of Ⅲ degree at early stage after the hemorrhage.