标准外伤大骨瓣减压术治疗幕上高血压脑出血并脑疝形成63例

目的探讨幕上高血压脑出血脑疝形成患者的手术方式、手术技巧及疗效评价。方法将广东省高州市人民医院神经外科近4年收治幕上高血压脑出血脑疝形成63例患者的临床资料进行分析,均急诊在静脉全麻下行血肿清除、标准外伤大骨瓣减压术,部分患者行额、颞叶切除内减压或天幕切开术;对于血肿超过80 ml或短期内出现双侧瞳孔散大者,先快速小骨窗清除部分血肿后再行上述手术;伴有脑室内出血患者行脑室外引流术。结果全组63例中,死亡9例,病死率14.3%;存活患者3个月后日常生活能力（ADL）使用Barthe1指数评定,良好21例,中度残废l5例,重度残废l0例,完全依赖8例。结论急诊手术尽快清除血肿、标准外伤大骨瓣减压、脑组织保护、脑疝复位或天幕切开是提高治愈率及生存质量的关键;瞳孔散大固定患者预后不良。

Standard large trauma craniotomy in treating 63 cases of supratentorial hypertensive intracerebral hemorrhage combined with hernia

Objective To investigate the surgical procedure,surgical techniques and evaluation for patients with supratentorial hypertensive intracerebral hemorrhage combined with hernia. Methods All 63 patients were received removal of hematoma immediately and standard large trauma craniotomy in general anesthesia.Some patients recieved frontal and temporal lobectomy or incision of tentorial.The priority is removal of some hematoma in small bone window before other treatment in the cases which hematoma more than 80 ml...