显微外科治疗重型脑干出血

目的探讨显微外科治疗重型脑干出血的指征、手术方法和效果。方法回顾性分析2006年2月至2010年4月显微手术治疗的34例出血量5~18ml、GCS评分4~7分的重型脑干出血病人的临床资料。结果 34例经36次显微手术全部清除血肿,其中16例经颞下锁孔开颅手术。术后7d内清醒4例,其中2例GCS评分5分的患者,术后第2天即恢复部分意识。术后死亡3例。31例随访6月~3年,生活能自理4例,部分自理9例,清醒但重残5例,微弱意识2例,植物生存5例,死亡6例。结论早期应用显微手术清除血肿,加强围手术期的综合处理,可明显改善重型脑干出血患者的预后。

Microsurgery for severe brainstem hemorrhage(a report of 34 cases)

Objective To explore the indication and skills of microsurgery for severe brainstem hemorrhage and its curative effect. Methods The clinical data of 34 patients with severe brainstem hemorrhage （the volume of bleeding ranged from 5 to 18 ml）, who underwent microsurgery from February, 2006 to April, 2010 in our hospital, were analyzed retrospectively. GCS ranged from 4 to 7 scores on admission in the patients. Results The hemotomas were successfully removed by 36 operations in all the patients. The subtemporal craniotomy through keyhole approachs were performed in 16 of 34 patients. The consciousness was recovered 2 days after the surgery in 2 patients with 5 scores of GCS and 2 patients recovered their consciousness 7 days after the surgery. Three patients died after the operation. Of 31 patients followed up from 6 months to 3 years, 4 were recovered well, 9 mildly disabled, 7 severely disabled, 5 vegetatively survived and 6 died. Conclusion The prognosis can be significantly improved in patients with severe brainstem hemorrhage by removal of the hematomas early after the hemorrhage and enhancing perioprative comprehensive treatment.