中国微创外科杂志
中國微創外科雜誌
중국미창외과잡지
CHINESE JOURNAL OF MINIMALLY INVASIVE SURGERY
2014年
11期
1015-1018
,共4页
脑出血%高血压%基底神经节%血肿%微创%穿刺术%引流术
腦齣血%高血壓%基底神經節%血腫%微創%穿刺術%引流術
뇌출혈%고혈압%기저신경절%혈종%미창%천자술%인류술
Intracranial hemorrhage%Hypertension%Basal ganglia%Hematoma%Minimally invasive%Punctures%Drainage
目的：对比开颅血肿清除和硬通道穿刺治疗高血压基底节区脑出血的效果及预后。方法回顾性分析2005年1月～2013年12月我科192例高血压脑出血的临床资料，其中开颅血肿清除术（开颅组）和穿刺引流术（微创组）各96例。2组年龄、性别、血肿侧别及Glasgow昏迷评分差异无显著性（P＞0．05）。对比2组术中出血量、术后残余血肿量、手术时间、住院时间和术后3周及6个月的临床疗效。结果与开颅组比较，微创组手术时间短[中位数31（24～39） min vs．152（131～170）min，Z＝-11．975，P＝0．000]，术中出血少[30例0 ml、66例＜5 ml vs．（332．4±20．2）ml]，术后住院时间短[中位数14（10～17）d vs．64（44～75）d，Z＝-44．217，P＝0．000]，但术后残余血肿量多[中位数13（8～17）ml vs．7（4～12）ml， Z＝-11．573，P＝0．000]。治疗3周后，微创组Glasgow 预后评分高[中位数4（2～4）分 vs．3（1～4）分，Z＝-8．215，P＝0.000]，Barthel指数高[（59．9±4．5） vs．（54．9±4．9），t＝7．370，P＝0．000]。治疗6个月，微创组Glasgow预后评分高[中位数3（2～4）分vs．2（1～4）分，Z＝-7．448，P＝0．000]，Barthel指数高[（64．3±8．4） vs．（59．7±6．8），t＝4．156，P＝0．000]，2组病死率差异无显著性（P＞0．05）。结论微创颅内血肿硬通道穿刺引流术在一定程度上明显优于开颅血肿清除术，值得临床推广应用。
目的：對比開顱血腫清除和硬通道穿刺治療高血壓基底節區腦齣血的效果及預後。方法迴顧性分析2005年1月～2013年12月我科192例高血壓腦齣血的臨床資料，其中開顱血腫清除術（開顱組）和穿刺引流術（微創組）各96例。2組年齡、性彆、血腫側彆及Glasgow昏迷評分差異無顯著性（P＞0．05）。對比2組術中齣血量、術後殘餘血腫量、手術時間、住院時間和術後3週及6箇月的臨床療效。結果與開顱組比較，微創組手術時間短[中位數31（24～39） min vs．152（131～170）min，Z＝-11．975，P＝0．000]，術中齣血少[30例0 ml、66例＜5 ml vs．（332．4±20．2）ml]，術後住院時間短[中位數14（10～17）d vs．64（44～75）d，Z＝-44．217，P＝0．000]，但術後殘餘血腫量多[中位數13（8～17）ml vs．7（4～12）ml， Z＝-11．573，P＝0．000]。治療3週後，微創組Glasgow 預後評分高[中位數4（2～4）分 vs．3（1～4）分，Z＝-8．215，P＝0.000]，Barthel指數高[（59．9±4．5） vs．（54．9±4．9），t＝7．370，P＝0．000]。治療6箇月，微創組Glasgow預後評分高[中位數3（2～4）分vs．2（1～4）分，Z＝-7．448，P＝0．000]，Barthel指數高[（64．3±8．4） vs．（59．7±6．8），t＝4．156，P＝0．000]，2組病死率差異無顯著性（P＞0．05）。結論微創顱內血腫硬通道穿刺引流術在一定程度上明顯優于開顱血腫清除術，值得臨床推廣應用。
목적：대비개로혈종청제화경통도천자치료고혈압기저절구뇌출혈적효과급예후。방법회고성분석2005년1월～2013년12월아과192례고혈압뇌출혈적림상자료，기중개로혈종청제술（개로조）화천자인류술（미창조）각96례。2조년령、성별、혈종측별급Glasgow혼미평분차이무현저성（P＞0．05）。대비2조술중출혈량、술후잔여혈종량、수술시간、주원시간화술후3주급6개월적림상료효。결과여개로조비교，미창조수술시간단[중위수31（24～39） min vs．152（131～170）min，Z＝-11．975，P＝0．000]，술중출혈소[30례0 ml、66례＜5 ml vs．（332．4±20．2）ml]，술후주원시간단[중위수14（10～17）d vs．64（44～75）d，Z＝-44．217，P＝0．000]，단술후잔여혈종량다[중위수13（8～17）ml vs．7（4～12）ml， Z＝-11．573，P＝0．000]。치료3주후，미창조Glasgow 예후평분고[중위수4（2～4）분 vs．3（1～4）분，Z＝-8．215，P＝0.000]，Barthel지수고[（59．9±4．5） vs．（54．9±4．9），t＝7．370，P＝0．000]。치료6개월，미창조Glasgow예후평분고[중위수3（2～4）분vs．2（1～4）분，Z＝-7．448，P＝0．000]，Barthel지수고[（64．3±8．4） vs．（59．7±6．8），t＝4．156，P＝0．000]，2조병사솔차이무현저성（P＞0．05）。결론미창로내혈종경통도천자인류술재일정정도상명현우우개로혈종청제술，치득림상추엄응용。
Objective To compare the effects and prognosis of craniotomy evacuation of hematoma and hard tunnel minimally invasive perforation for hypertensive basal ganglia hemorrhage ( HBGH ) . Methods A total of 192 patients with HBGH from January 2005 to December 2013 were retrospectively reviewed , including 96 cases of craniotomy evacuation of hematoma and 96 cases of minimally invasive puncture drainage .No significant differences were found in age , gender, lesion side,and Glasgow coma scale between the two groups ( P >0.05 ).The intraoperative bleeding volume , postoperative residual hematoma , operation time, hospitalization duration , and the postoperative clinical curative effects at 3 weeks and 6 months after operation were compared between the two groups . Results As compared with the craniotomy group , the operation time of the hard tunnel minimally invasive perforation group was significantly shorter [31 (24 -39) min vs.152 (131 -170) min, Z =-11.975, P =0.000], the intraoperative blood loss was significantly less [0 ml in 30 cases and <5 ml in 66 cases vs.(332.4 ±20.2) ml],and the hospitalization duration was significantly shorter [14 (10-17) d vs.64 (44-75) d, Z=-44.217, P=0.000].However, the postoperative residual hematoma was larger in the hard tunnel minimally invasive perforation group than in the craniotomy group [13 (8-17) ml vs.7 (4-12) ml, Z=-11.573, P=0.000].At the third week of postoperation , the Glasgow Outcome Scale in the hard tunnel minimally invasive perforation group was higher [4 (2-4) vs.3 (1-4), Z=-8.215, P=0.000], and the Barthel Index was higher [(59.9 ±4.5) vs.(54.9 ±4.9), t=7.370, P=0.000] than the craniotomy group.At sixth month postoperation, the Glasgow outcome scale in the hard tunnel minimally invasive perforation group was higher [3 (2-4) vs.2 (1-4), Z=-7.448, P=0.000], and the Barthel Index was higher [(64.3 ±8.4) vs.(59.7 ±6.8), t=4.156, P=0.000].No significant differences in mortality were found between the two groups (P >0.05). Conclusion Minimally invasive hard tunnel puncture drainage is significantly superior to craniotomy evacuation of hematoma in the treatment of HBGH and deserves to be promoted for clinical performance .
