摘要
目的分析小骨窗开颅显微手术治疗基底节区脑出血的效果。方法对56例具备手术指征的高血压脑出血患者,采取颞部小骨窗开颅,穿刺定位血肿腔后于显微镜下操作清除血肿。结果 56例患者术后复查头颅CT,血肿完全清除者18例,血肿清除量>2/3者35例,占位效应均明显减轻或消失;血肿残余量大于>2/3者2例,予以保守治疗后好转;再出血(出血较术前增加)1例,再次行急诊手术清除。本组56例患者中术后生存47例,死亡6例,另有3例因经济原因自动出院。存活47例于术后3个月随访,日常生活能力(ADL)评价:Ⅰ级9例(19.1%),Ⅱ级15例(32.0%),Ⅲ级13例(27.6%),Ⅳ7例(14.9%),Ⅴ级3例(6.4%)。结论小骨窗开颅显微手术治疗基底节区脑出血效果较好,能有效清除血肿,较好地体现了微创手术及快速康复外科理念。
Objective To exploring the right moment and effevtive operation method for hypertensive cerebral hemorrhage.To sum up and study the treatment experience of the case by craniotomy with small skull window.Methods 56 cases of hypertensive intracerebral hemorrhage with surgical indications were treated by craniotomy with small bone window of temporal bone.The hematoma cavity was located and the hematoma was removed under microscope.Results 56 cases reviewed CT after surgery：the hematoma was completely removed in 18 cases,the amount of hematoma of 35 cases removed was more than 2/3,the mass effects were significantly reduced or disappeared.There were 2 cases with hematoma residual volume greater than〉2/3,were cured after conservative treatment,and then bleeding（bleeding increased compared with preoperative）in one cases,emergency surgery was performed again.In the 56 cases,47 cases survived,6 died,and 3 cases were discharged automatically because of economic reasons.Survival in 47 cases was followed up in March and evaluated by daily living ability（ADL）：GradeⅠ,9（19.1%）,gradeⅡ,15（32%）,grade Ⅲ,13（27.6%）,gradeⅣ,7（14.9%）,grade Ⅴ,3（6.4%）.Conclusion Such a small skull window for evacuating hematornas will be safty,effectiveness,with few complications and litter injury therapeutic method for operation of hypertensive intracerebral hemorrhage.
出处
《基层医学论坛》
2017年第29期3955-3956,共2页
The Medical Forum
基金
德阳市重点科学技术研究项目(2014SZ100-4)
关键词
颅内出血
高血压性
外科手术
微创
血肿
小骨窗开颅术
Intracranial hemorrhage
Hypertensive
Surgical procedures
Minimally invasive
Hematoma
Small-skull-window operation
