显微手术治疗高血压脑干出血

目的探讨显微开颅手术治疗高血压脑干出血的可行性。方法对4例高血压脑干出血进行显微手术治疗。3例取枕下正中直切口经小脑扁桃体延髓间隙入路,1例取一侧经小脑脑桥角的枕下乙状窦后入路;在显微镜下找到并清除血肿,直视下弱电流止血。结果3例术后呼吸仍不规则,呼吸器辅助呼吸1～2d后自主呼吸即平稳。1例术后意识恍惚后逐渐好转,未行气管切开。随访3～18月,所有病人均生存良好,但遗留Ⅴ、Ⅶ神经损害和不同程度偏瘫,其中1例术前昏迷病人术后0.5年可扶拐行走。结论显微开颅手术治疗高血压脑干出血,是一种行之有效的方法。

Microsurgery of hypertensive brain stem hemorrhage

Objective To research the feasibility of micro-craniotomy treatment of hypertensive brain stem hemorrhage.Methods The4cases with hypertensive hemorrhage of brain stem underwent microsurgery treatment.Among them,3cases adopted the approach of cerebello-tonsillar-medulla oblongate space across the suboccipito-median straight incision,1case adopted the suboccipito-retrosigmoidal approach across the cerebellon-pontile angle.The hemotoma was found under microscope and hemorrhagic spot was coagulated by weak electric current under direct vision.Results After operation3cases still had irregular respiration;after1-2days of assisted respiration by respirator,their breath went to smooth;1case was in vague mind,but his consciousness got better gradually and didn't undergo tracheotomy.The4cases all survived well after3-18months of follow-up.But they remainⅤ,Ⅶnerves injury and hemiplgia of different extent.Among four cases,one,who wa s in coma before operation,could walk by cane half year after operation.Conclusion Micro-craniotomy is a effective way for hypertensive brain stem hemorrhage.