摘要
目的探讨不同部位高血压性脑出血的有效术式。方法2001年1月～2003年8月,对85例不同部位高血压性脑出血采取不同手术方式。40例皮层下、基底节区外侧型未出现脑疝者,采用局麻加强化麻醉下小骨窗开颅血肿清除术;26例基底节区内侧型未出现脑疝者,采用局麻加强化麻醉下头皮小切口颅骨钻孔血肿穿刺抽吸术;11例术前脑疝及6例小脑半球出血者采用静脉全麻,开颅清除血肿;2例脑干出血破入第四脑室者采取侧脑室外引流术,其他部位出血破入脑室加用侧脑室外引流。结果85例病死率129%(11/85),其中皮层下、小脑、脑干、基底节区外侧型未出现脑疝的病例无死亡;基底节区内侧型病死率290%(9/31);11例术前脑疝的病死率455%(5/11)。结论皮层下、基底节区外侧型未出现脑疝的病人经局麻小骨窗开颅清除血肿效果显著,小脑出血经积极手术预后良好,基底节区内侧型出血经局麻小切口钻孔抽吸效果较差。
Objective To discuss effective methods for treating hypertensive intracerebral hemorrhage at the different sites. Methods Different operative methods were adopted in 85 cases of hypertensive intracerebral hemorrhage at the different sites from January 2001 to August 2003 in this hospital. Small fenestration and hematoma clearance under local intensify anesthesia was conducted in 40 cases of hemorrhage under the cortex or in the lateral area of the basal ganglia and without brain hernia; small incision trepanation with suction and drainage of hemorrhage under local intensify anesthesia was used in 26 cases of hemorrhage in the medial area of the basal ganglia without brain hernia; craniotomy and hematoma clearance under general anesthesia was adopted in 11 cases of preoperative brain hernia and 6 cases of cerebellar hemispheric hemorrhage; lateral ventricle external drainage was adopted in 2 cases of brain stem hemorrhage involving into the fourth ventricle and also in these cases with ventricle involved. Results The overall mortality rate was 12 9% (11/85). There were no deaths in cases of hemorrhage without brain hernia,under the cortex, in the cerebellum, in the brain stem or in the lateral area of the basal ganglia.The mortality was 29 0% (9/31) in cases of hemorrhage in the medial area of the basal ganglia and 45 5% (5/11) in cases of preoperative brain hernia, respectively. Conclusions Small fenestration and hematoma clearance under local anesthesia is effective for hemorrhage under the cortex or in the lateral area of the basal ganglia and without brain hernia. Provided surgical treatment is early and adequate, the prognosis of cerebellar hemorrhage is excellent. Small incision trepanation with suction and drainage under local anesthesia exerts no appreciable effect on hemorrhage in the medial area of the basal ganglia.
出处
《中国微创外科杂志》
CSCD
2004年第5期429-429,431,共2页
Chinese Journal of Minimally Invasive Surgery
关键词
高血压病
脑出血
Hypertension
Brain hemorrhage
