摘要
目的 评价小骨窗开颅显微手术治疗高血压性基底节区脑出血的手术疗效及安全性。 方法 自 1992年 2月～ 2 0 0 2年 7月 ,70例高血压性基底节区脑出血病例被同期分为小骨窗开颅组与传统大骨窗开颅组 ,行显微手术治疗。比较两组在显露及清除血肿方面、对出血动脉止血方面、对周围脑组织保护和手术减压方面的效果 ,同时对两组的术中出血、手术所用的时间、术后平均住院时间、远期疗效进行统计学分析 ,通过测量总结小骨窗开颅的适宜尺寸。 结果 小骨窗开颅组 3 9例 ,开颅窗最大径 (3 2 0± 0 42 )cm ;传统大骨窗开颅组 3 1例 ,开颅窗最大径为 (7 95± 0 47)cm。两组在术前一般情况、术前意识状态、血肿部位及血肿量、手术时机方面差异无显著性 (P >0 0 5 ) ,手术方面 ,两组在血肿显露、清除及对出血动脉止血方面差异无显著性 (P >0 0 5 ) ,小骨窗开颅组血肿清除术后减压满意。小骨窗开颅组有手术时间短、出血较少、平均住院时间短等优点 ((P <0 0 1) ,在远期效果方面小骨窗组也优于传统开颅组 (P <0 0 5 )。 结论 对高血压性基底节区脑出血的显微手术 ,小骨窗开颅术可达到传统大骨窗开颅手术的疗效及安全性标准。由于小骨窗开颅设计建立在术前对病变精确的空间定位基础上 ,以最适宜的?
Objective To evaluate the effectiveness and safety of individuated design,craniotomy with small bone flap approach minimally invasive surgery for hypertensive hemorrhage of basal ganglia region (HBGH,or Hypertensive Putaminal Hemorrhage,HPH). Methods In a prospective clinical trail,70 patients with HPH were randomly assigned into two groups to receive emergency microsurgical treatment from Feb.of 1992 to July of 2002.Patients with a decreased level of consciousness and/or a severe neurological deficit were admitted to the study.Two groups were divided by the size of craniotomy.Group one was small craniotomy group,the approach and the size of craniotomy were designed according to the shape and location of hematoma demonstrated by CT.Group two was the traditional craniotomy group.Both were analyzed of hematoma revelation,evacuation,coagulation,edema of brain after operation,volume of bleeding,operative time,period of postoperative and long-term effect. Results The mean size of craniotomy in group one was (3.20±0.42) cm;the mean size of craniotomy in group two was (7.95±0.47)cm.Two groups had no statistical difference in terms of the revelation,coagulation,and rate of clearance degree of hematoma ( P >0.05).But there was less operation time and less volume of bleeding in the group one ( P <0.01),and postoperative cerebral edema was quite limited in group one,which enables the bone flap be replaced at the same procedure ( P <0.01).Long-term effect of group one was better than the traditional group ( P <0.05). Conclusions The craniotomy with small bone flap has the same effectiveness and safety with the traditional routine craniotomy,and it is more minimally invasive method for operation of hypertensive intracerebral hemorrhage.
出处
《中华显微外科杂志》
CSCD
北大核心
2004年第2期89-92,共4页
Chinese Journal of Microsurgery
