高血压脑出血外科治疗的回顾性研究

目的探讨高血压脑出血不同手术的适应证、手术时机及疗效。方法回顾分析手术治疗高血压脑出血患者486例,对开颅血肿清除+去骨瓣减压术、小骨窗开颅血肿清除术、CT或立体定向引导下颅骨钻孔血肿腔置管+尿激酶容解引流术等手术方法,分别在发病后≤6、7～12、13～24h手术的结果分别进行了对比分析。术后随访时间1～24个月,平均7个月。结果①相同的手术方法,在≤6h手术后的良好率明显高于7～12h和13～24h(P<0.05,P<0.01);②不同的手术方法,相同的手术时机,术后疗效有显著性差异(P<0.01);③在不同的出血量、相同手术时机的同一手术方法术后良好率有显著性差异(P<0.01);④同一手术早期与晚期术后结果有显著性差异。结论①高血压脑出血,手术时机越早、清除血肿越彻底越好;②脑出血量超过40ml,应选择开颅血肿清除+去骨瓣减压术;③脑出血手术效果与血肿量多少相关。

Surgical treatment of hypertensive intracerebral hemorrhage: A retrospective study

Objective To explore the different surgical effects-surgical indications and operating times on patients with hypertensive intracerebral hemorrhage.Methods A retrospective analysis of surgical effects was made among 486 patients with hypertensive intracerebral hemorrhage.The surgical approaches included:Hemotoma-removed craniotomy bone-removed flop decompression-hemotoma-removed craniotomy with small bone window-burr hole drainage and urokinase perfusion for treatment of intracerebral hematoma by CT or stereotactic surgery.The surgical findings were recorded at 6h-7-12h and 13-24h after intracerebral hemorrhage- and compared with each other at every time point. Postoperative follow-up ranged from 1 to 24 months-mean 7 months.Results (1)At the same surgical approaches-within 6h-the rate of excellence was significant higher than that of within 7-12h and 13-24h group postoperatively(P<0.05,P<0.01);(2)At the different surgerical approaches-the same operating time-the rate of excellence was significant change (P<0.01) than that of within 7-12h and 13-24h group postoperatively(P<0.05,P<0.01);(3)At different intracerebral hemorrhage-at the same operating time and surgerical approache-the rate of excellence was significant change(P<0.01);(4)The outcome of early operations were siganicant different than that of the late operations (P<0.01) postoperatively.Conclusion (1)The earlier is operation and the more thorough is hemotoma-removed-the better is results of operative therapy;(2)While the volume of intracerebral hemorrhage more than 40ml- the Hemotoma-removed craniotomy bone-removed flop decompression should be selected;(3)The operative curative effect is significantly related to the volume of hemotoma.