296例高血压性脑出血显微外科微创治疗分析(1)
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【摘要】 目的 探讨高血压性脑出血患者采用显微外科联合小骨窗微创治疗后的效果，指导临床术式选择。 方法 回顾性分析单纯小骨窗手术139例，显微外科联合小骨窗微创手术157例，按照颅内血肿清除率、术后大面积脑梗死发生率评定手术效果，按照日常生活能力表(ADL)分级评定预后进行统计分析。结果 术后血肿残留、术后大面积脑梗死发生率和预后分级有统计学差异，显微外科联合小骨窗组各项指标优于单纯小骨窗手术组。结论 显微外科联合小骨窗微创手术治疗高血压性脑出血，能提供良好的照明和视野，并且提高病变的放大视觉效果，能够直视下清除血肿，提高血肿清除率，减少了术后大面积脑梗死的发生，有利于改善患者预后。
【关键词】 颅内出血；微创神经外科；微骨窗入路
Therapeutic effect of microsurgical technique with Key-hole approach for 296 cases of hypertensive intracranial hemorrhage
WANG Tong-tong,ZHENG De-qun.
Department of Brain surgery,Suzhou city Hospital in Anhui Province,Suzhou 234000,China
【Abstract】 Objective To investigate the microsurgical technique with Key-hole approach for hypertensive intracranial hemorrhage. Methods 139 patients were operated only with Key-hole approach and 157 patients were operated with Key-hole approach with microsurgical technique, respectively. The clearance percentage, incidence rate of mass area infarction, score of ADL were retrospectively analyzed and compared between two groups. Results The clearance percentage and incidence rate of mass area infarction in group with Key-hole approach with microsurgical technique were significantly lower than those in group only with Key-hole approach (15.8%vs 7.6%,8.6%vs 3.2%,both P<0.05)；meanwhile, the score of ADL in group with Key-hole approach with microsurgical technique was significantly higher than another(70.7%vs 59.7%,P<0.05). Conclusion Key-hole approach with microsurgical technique can provide good illumination and the field of vision, enhances pathological changes enlargement vision effect, raises the haematoma clearance percentage, reduces the incidence rate of mass area infarction, and improves prognosis of patients.
【Key words】 Intracranial hemorrhage;Hypertensive；Minimally invasive neurosurgery； Key-hole approach
高血压脑出血是病死率和致残率都较高的疾病，早期病死率可高达49.4%,脑深部出血死残率更高。目前对于高血压脑出血是否行手术治疗仍持不同意见，Mendelow[1]的研究表明早期手术治疗和保守治疗对于预后无明显差异，尤其对于深部血肿和脑干血肿，外科手术效果不佳，但是仍有大多数研究表明，高血压性脑出血外科治疗的疗效确切[2]，目的是采用适当的术式，及时清除血肿缓解或解除脑受压，同时避免任何不必要的脑损伤与由此造成或加重的伤残，达到在挽救生命的同时，降低残废率和提高生存质量。本院曾采用小骨窗开颅血肿清除术治疗高血压脑出血，取得满意效果[3]，在此基础上引入显微外科技术，疗效显著，明显改善患者预后，现分析总结如下。
1 资料与方法
1.1 一般资料 本研究纳入标准：高血压自发性脑出血 ......
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