高血压脑出血外科治疗对照研究

目的对比高血压脑出血（HICH）的大骨瓣开颅（COC）、CT引导血肿微创穿刺引流（CTGA）和微骨窗入路（KHA）三种手术方法，分析手术疗效。方法手术治疗493例出血性脑卒中病例，完成3个月随访，采用对照研究方法比较不同手术方式疗效。结果493例中大骨瓣组128例，微骨窗组82例，微创穿刺引流组283例。1个月累计病死率19．3％，3个月累计病死率21．1％。术前Glasgow昏迷评分（GCS）≤8分的病人，术后3个月病死率是GCS／〉8分的3．5倍。结论微骨窗入路及CT引导微创穿刺引流术组治疗高血压脑出血的手术病死率与致残率优于大骨瓣开颅组。

Comparative study of neurosurgical treatments for hypertensive intracerebral hemorrhage

Objective To compare the effects and indications of three approaches among conventional open craniotomy（ COC ） , computed-tomography guided aspiration （ CTGA ） and key-hole approach（KHA） in neurosurgical management for hypertensive intracerebral hemorrhage （HICH）. Methods The clinical data of 493 patients with HICH were collected and underwent single-blind study. Results Among 493 patients, 128 underwent COC,283 CTGA and 82 through KHA. The overall mortality rates within one and three months after operation were 19. 3% and 21. 1% respectively. The mortality rate within 3 months after operation of the patient with GCS≤8 was 3.5 times than the patients with GCS ≥8. Conclusion KHA and CTGA are both better than COC in treatment of HICH with more favorable outcome and less postoperative mortality and morbidity.