CAJ | 학술논문

目的探讨高血压脑出血各种术式与出血部位、出血量、手术时机及结局的关系.方法对6所医院神经外科2004年1月至2012年1月住院手术的1310例患者,按骨瓣开颅(A组)、小骨窗手术(B组)、定向置管引流(C1组、C2组)、神经内镜手术(D组)、脑室置管引流(E组)的手术方式分为6组,结合出血部位、出血量及临床实际,对选择手术时机和术式的疗效进行回顾性分析.结果 ①80 mL以上的深、浅部血肿致脑疝中晚期,宜选用骨瓣开颅.②50～80 mL的深、浅部血肿,宜选用定向置管引流或神经内镜手术.③20 ～ 50 mL的深、浅部血肿,宜选用定向置管引流.④脑室出血宜选用置管引流;脑室铸型宜选用神经内镜手术.⑤80 mL以下出血手术时机6～12h为妥,出血量大应及时手术以挽救生命,要根据病人的具体情况灵活掌握.结论高血压脑出血大量出血或脑疝以骨瓣开颅为妥,80 mL以下血肿以定向置管引流为宜,也要根据出血部位、出血量,选择手术时机和手术方式,个体化治疗才能进一步提高疗效.
목적 탐토고혈압뇌출혈각충술식여출혈부위、출혈량、수술시궤급결국적관계.방법 대6소의원신경외과2004년1월지2012년1월주원수술적1310례환자,안골판개로(A조)、소골창수술(B조)、정향치관인류(C1조、C2조)、신경내경수술(D조)、뇌실치관인류(E조)적수술방식분위6조,결합출혈부위、출혈량급림상실제,대선택수술시궤화술식적료효진행회고성분석.결과 ①80 mL이상적심、천부혈종치뇌산중만기,의선용골판개로.②50～80 mL적심、천부혈종,의선용정향치관인류혹신경내경수술.③20 ～ 50 mL적심、천부혈종,의선용정향치관인류.④뇌실출혈의선용치관인류;뇌실주형의선용신경내경수술.⑤80 mL이하출혈수술시궤6～12h위타,출혈량대응급시수술이만구생명,요근거병인적구체정황령활장악.결론 고혈압뇌출혈대량출혈혹뇌산이골판개로위타,80 mL이하혈종이정향치관인류위의,야요근거출혈부위、출혈량,선택수술시궤화수술방식,개체화치료재능진일보제고료효.
Objective To explore the relationship between different hemorrhage position,hemorrhage volume,surgical time and outcome of treatment with surgical methods of HICH.Methods A total of 1310 patients were admitted from six hospitals from January 2004 to January 2008,the 1310 patients were divided into six groups according to different operation:craniotomy through bone flap (group A),craniotomy through small bone window (group B),stereotactic drilling drainage (group C1 and group C2),neuron-endoscopy operation (group D) and external ventricular drainage (group E),considering hemorrhage position,hemorrhage volume,surgical time and result of surgical methods were reviewed and analyzed.Results ①Craniotomy through bone flap should be selected with the case of superficial or deep hematoma volume (＞ 80 mL),median line structure distinct motion,metaphase or advanced stage of hernia of brain.②Craniotomy through small bone window and neuron-endoscopy should be selected with the case of moderate hematoma volume (50-80 mL) ③Drilling drainage should be selected with the case of small hematoma volume in superficial or deep hematoma volume (20-50 mL) ④Extemal drainage should be selected in dealing with ventricular hemorrhage.Small bone window or neuron-endoscopy should be selected in ventricular casting mould.⑤The appropriate operation time for patients with hematoma volume less than 80 mL should be 6-12 hours and large hematoma should be immediately operated to save lives.The operation time should depend on patients detail condition.Conclusions Craniotomy through bone flap was suitable for large hematoma and hernia of brain; Stereotactic drilling drainage should be selected in patients with hematoma volume less than 80mL; and the operation results in dealing with HICH would be improved via suitable operation time and surgical methods and adividual according to Hemorrhage position and Hemorrhage volume.