高血压幕上脑叶出血患者去留骨瓣手术疗效比较

目的 探讨高血压幕上脑叶出血手术保留骨瓣与去骨瓣减压的临床疗效.方法 选择2009年10月至2015年6月安徽医科大学第二附属医院收治的高血压幕上脑叶出血患者31例,均行显微手术治疗,幕上脑叶出血量均超过30 mL.31例患者按手术方式分为清除血肿加去骨瓣组(DC组,12例)和单纯清除血肿并保留骨瓣组(HR组,19例),比较两组患者术前GCS评分、术前脑叶出血量、中线偏移程度、手术距发病时间、住院时间、术后3个月预后、运动与认知改善情况等.结果 两组患者的年龄、性别、GCS评分、术前脑叶出血量、中线偏移程度、手术距发病时间、术后运动及认知改善等差异无统计学意义(P>0.05),而DC组住院时间长于HR组,HR组术后3个月的预后优于DC组,差异有统计学意义(P<0.05).结论 对于高血压幕上脑叶出血患者,如果手术能够彻底清除血肿,去骨瓣减压可能并无必要.保留骨瓣可能缩短患者住院时间,改善患者术后3个月预后.

Retrospective comparison of clinical effect between craniotomy and decompressive craniectomy for surgical evacuation of lobar supratentorial hypertensiveintracerebral hemorrhage

Objective To evaluate and compare the clinical effect between a lobar hypertensive hematoma removal plus decompressive craniectomy group (DCgroup) and a lobar hypertensive hematoma removal group (HRgroup).Methods From October 2009 to June 2015,31 consecutive supratentorial lobar intracerebral hemorrhage(ICH) patients who underwent microsurgery in our hospital were retrospectively analyzed.Supratentorial ICHs that exhibited a hematoma volume of over 30 mL were included in this study.We compared the DCgroup and the HRgroup with regard to age,sex,side, GCS, preoperative hematoma volume, shift from the midline, time from the ictus to surgery, hospitalization periods, and prognosis in three months after surgery,improved motor function,improved cognition after three months. Statistical analysis was accordingly conducted.Results Age,sex,side, GCS, preoperative hematoma volume, shift from the midline, time from the ictus,improved motor function,improved cognition were similar between two groups(P>0.05). Hospitalization periods increased in the DC group with statistical significance. The prognosisafter 3 months was better inthe HR groupthan in DC group with statistical significance(P<0.05). Conclusion Decompressive craniectomy is not necessary for rescue in lobar ICH if the hematoma can be removed completely.Surgical evacution of the hematoma might decrease the hospitalization and improve the patient's prognosis in three months after surgery.