高血压脑出血微创手术治疗进展

高血压脑出血具有很高的发病率、病死率和致残率，为社会、家庭带来了沉重的健康及经济负担，但高血压脑出血也是脑卒中亚分类中仅有的没有明确治疗标准的疾病，传统开颅手术在高血压脑出血中应用广泛，但目前没有明确证据支持其可以提升患者的神经功能及预后。微创手术逐渐得到了越来越为广泛的应用。本文主要探讨了立体定向血肿抽吸、神经内镜技术以及纤溶药物治疗高血压脑出血的发展及现状。随着神经影像学的快速发展，立体定向血肿抽吸治疗高血压脑出血的治疗效果愈发理想；通过不断的改进，神经内镜清除血肿的效果愈发理想，而内镜手术入路的选择仍无统一标准；rtPA/尿激酶纤溶治疗尽管可以减少一定量的血肿，但是纤溶治疗与再出血及水肿加重之间的关系仍颇具争议。目前，仍需要更多的临床研究以进一步证实微创手术在治疗高血压脑出血中的作用。

Recent progress of minimally invasive surgery for hypertensive intracranial hemorrhage

Hypertensive intracranial hemorrhage (HICH) has high incidence and mortality, causing great economic and health burden. However, HICH is the only subgroup of stroke that has no clear treatment standard. Though traditional craniotomy still enjoys popularity in treating HICH, yet no clear clinical evidence support its benefit to neuronal function and prognosis. Recently minimally invasive surgery (MIS) begin to show great advantage to treat HICH. This review presented the current situation and recent progress of common MIS procedures for HICH, including stereotactic aspiration, neuro-endoscopic evacuation and fibrinolysis treatment.