显微手术治疗高血压性脑出血的临床体会

目的探讨小骨窗开路经颞叶颞叶皮质显微外科清除血肿的手术方法,提高对高血压脑出血的治疗水平。方法回顾性分析我科自2007年3月至2010年3月基底节区高血压性脑出血患者大骨瓣开颅减压以及采用经颞叶皮质入路以显微外科手术治疗126例,总结其手术方法,比较其入路与其他手术入路的优缺点,探讨手术技巧。结果 126例患者中完全清除血肿90例、大部分清除血肿15例,再出血5例、存活105例、死亡21例。根据日常生活活动能力评分（activities of daily living,ADL）分级,手术后随访3个月,105例生存者预后达I级者6例,Ⅱ级43例,Ⅲ级18例,Ⅳ级26例,Ⅴ级13例。结论显微手术治疗基底节区脑出血,手术创伤小,时间短,止血可靠,安全有效。手术脑组织损伤小,可缩短昏迷时间,减少并发症,可提高患者生存率和生存质量。

Clinical Analysis of Microsurgery in Hypertensive Cerebral Hemorrhage

Objective To investigate the small bone window open after temporal lobe temporal cortex microsurgical removal of the hematoma surgical methods, improve the level of treatment of hypertensive cerebral hemorrhage. Methods A retrospective analysis was conducted from March 2007 to March 2010 the basal ganglia in patients with hypertensive cerebral hemorrhage and the use of large trauma craniotomy approach through the temporal cortex in surgical treatment of 126 cases of microsurgery, summarize the surgical method to compare their approach with the advantages and disadvantages of other surgical approaches to explore surgical techniques. Results 126 patients were completely remove the hematoma 90 cases, most of the removal of the hematoma in 15 cases, 5 cases of rebleeding, survival 105 cases, 21 cases of death. According to ADL score （activities of daily living, ADL） classification, post- operative follow-up three months, 105 cases of survival prognosis of six cases of grade I, II grade 43 cases, III grade 18 cases, IV grade 26 cases, class V 13 cases. Conclusion Microsurgical treatment of basal ganglia hemorrhage, surgical trauma, time is short, bleeding, reliable, safe and effective. Surgical brain damage, coma can shorten the time and reduce the complications that can improve patient survival and quality of life.