高血压基底节区脑出血不同手术方式探讨

目的 探讨高血压基底节区脑出血常规开颅、显微镜及神经内镜辅助小骨窗开颅三种手术方式的优劣. 方法 选择2008-10～ 2011-08期间连续性收治高血压基底节区脑出血病例80例,其中接受常规开颅手术35例、显微镜辅助小骨窗开颅26例、神经内镜辅助小骨窗开颅19例.采用SPSS17.0软件分析三组资料年龄、性别、术前GCS评分、发病至手术时间、血肿量及侧别、手术耗时、残余血肿量、随访6个月GOS评分情况,探讨不同术式优劣. 结果 三组患者年龄、性别、术前GCS评分、发病至手术时间、血肿量、血肿侧别无统计学差异(均P＞0.05)；三组间手术时间、术中出血量、术后残余血肿量有统计学差异(均P ＜0.05),两两比较显示显微镜辅助组与神经内镜组间无统计学差异(均P＞0.05),两组分别与常规开颅组比较之间有统计学差异(均P＜0.01).随访6个月,依据GOS评分判定预后,将GOS评分3-5分病例合并视为预后较好组、1-2分病例合并视为预后不良组进行预后情况比较,三组预后情况有统计学差异(均P ＜0.05)；两两比较神经内镜组与显微镜组预后情况无统计学差异(均P＞0.05),两组分别与常规开颅组比较预后情况有统计学差异(均P＜0.01). 结论 显微镜与神经内镜辅助下小骨窗手术治疗高血压基底节区脑出血较常规开颅手术能缩短手术时间、减少术中出血量和术后残余血肿量、改善患者预后,值得临床推广.

Different surgical techniques for hypertensive basal ganglia hemorrhage

Objective To compare the advantages and disadvantages of conventional craniotomy,microscope-assisted minicraniotomy and endoscope-assisted minicraniotomy for hypertensive basal ganglia hemorrhage(HBGH).Methods From October 2008 to September 2011,80 consecutive patients with HBGH were collected,including 35 cases of conventional craniotomy,26 cases of microscope-assisted minicraniotomy,and 19 cases of endoscope-assisted minicraniotomy.The clinical characteristics and results including age,gender,preoperative GCS score,time from ictus to operation,volumes and locations of intracerebral hematoma,operation time,residual hematoma and GOS score six months after operation were analyzed by SPSS17.0.In each group GOS score was evaluated in 6 months after operation,patients with 3-5 scores were defined as a column with good outcome,and 1-2 scores as a column with poor outcome.Results There was no significant difference in age,gender,preoperative GCS score,time from ictus to operation,volumes and locations of the intracerebral hematoma among three groups(P >0.05),but there was significant difference in the operation time,blood loss and residual hematoma volume(P<0.05).Those data between the microscope-assisted group and endoscope-assisted group were not statistically different(P>0.05).Compared with conventional craniotomy group,those data in the other two groups were significantly different(P<0.01).Patients in microscope-assisted and endoscope-assisted groups had better outcome than those in conventional craniotomy group(P<0.01),but the prognosis was not statistically different between microscope-assisted and endoscope-assisted groups(P>0.05).Conclusion Compared with conventional craniotomy,both microscope-assisted and endoscope-assisted minicraniotomy are better in the treatment of HBGH due to short operation time,less blood loss and residual hematoma,and better patients’outcome.