摘要
目的探讨微创手术治疗基底节脑出血的临床疗效及微创手术治疗的最佳时间。方法收集2005年至2012年基底节区脑出血>30 ml的患者,采用保守治疗的86例患者为对照组,小骨窗开颅手术治疗的89例患者为观察组1,CT定位微创血肿外引流术治疗的93例患者为观察组2,分析各组患者的治疗效果和手术治疗的最佳时间。结果微创血肿外引流术组手术时间明显短于小骨窗开颅手术组,术中出血也明显少于小骨窗开颅手术组。与保守治疗组和小骨窗开颅手术组比较,微创血肿外引流术组平均住院日缩短,病死率低,2周内NIHSS评分较低,神经功能恢复较好,差异具有统计学意义(P<0.05);以上各指标中,小骨窗开颅手术优于保守治疗组。脑出血后<6 h行微创手术,手术后再出血发病率较高,但平均住院日期明显缩短,神经功能有显著改善,总体病死率较低;脑出血后6～48 h行微创治疗再出血发病率较低;脑出血后48 h行微创治疗神经功能恢复无明显变化。结论 >30 ml基底节脑出血行微创血肿外引流术手术时间短,术中出血少,显著提高了疗效,显著降低病死率,有利于神经功能恢复,6 h内行微创治疗对减少住院时间、神经功能恢复有重要作用。
Objective To investigate the clinical effect of minimally invasive surgery and optimal time for surgery in the treatment of basal ganglia hemorrhage. Methods Patients with basal ganglia hemorrhage （ 〉 30 ml） from 2005 to 2012 were selected in the study. These patients were divided into control group （ n = 86 ） who received conservative treatment, observation group 1 （ n = 89 ） who received small bone window craniotomy, and observation group 2 （ n = 93 ） who received CT-gnided minimally invasive hematoma drainage. The treatment outcome of each group and the optimal time for surgery were analyzed. Results Observation group 2 had a significantly shorter duration of surgery and significantly less hemorrhage during surgery than observation group 1. Compared with the control group and observation group 1, observation group 2 had a shorter mean length of hospital stay, a lower fatality rate, a lower NIHSS score within 2 weeks, and a better recovery of neurological function （P 〈 0.05）, and observation group 1 showed improvements in the above indices compared with the control group. The patients who underwent minimally invasive surgery within 6 hours after cerebral hemorrhage had a higher rehemorrhage rate after operation, a shorter mean length of hospital stay, improved neurological function, and a lower overall fatality rate, as compared with those who underwent surgery at 6 - 48 hours and later than 48 hours after cerebral hemor- rhage. The patients who underwent minimally invasive surgery at 6 -48 hours after cerebral hemorrhage had a relatively low rehemorrhage rate; the patients who underwent minimally invasive surgery later than 48 hours after cerebral hemorrhage showed no significant improvement in neurological function. Conclusions For basal ganglia hemorrhage （ 〉 30 ml）, minimally invasive hematoma drainage, which has a short duration of surgery and causes little hemorrhage, has a significantly improved clinical effect, and it can significantly reduce the fatality and promote the
出处
《国际神经病学神经外科学杂志》
2013年第2期123-127,共5页
Journal of International Neurology and Neurosurgery
关键词
基底节区脑出血
小骨窗开颅手术
微创血肿外引流术
basal ganglia hemorrhage
small bone window craniotomy
minimally invasive hematoma drainage
