中国实用医刊
中國實用醫刊
중국실용의간
CENTRAL PLAINS MEDICAL JOURNAL
2014年
1期
51-53
,共3页
高血压脑出血%显微外科%开颅手术
高血壓腦齣血%顯微外科%開顱手術
고혈압뇌출혈%현미외과%개로수술
Hypertensive intracerebral hemorrhage%Microsurgery%Craniotomy
目的 回顾性分析应用显微技术小骨窗开颅手术治疗高血压壳核出血120例的治疗效果,探讨开颅手术的策略与技巧.方法 高血压壳核出血120例,开颅手术,在距额骨颧突8 cm,围绕外侧裂的体表线,额颞弧形切口,做直径4 cm的骨窗,在中央前回下点外侧裂上缘无血管处前后方向切开皮层2～3 cm.用1 cm宽的脑板分开至血肿腔清除血肿,然后在显微镜下操作,清除残余血肿,电凝止血.术后控制血压,保持引流管通畅,12 h复查CT,评价手术效果.结果 血肿清除80％以上98例(82.0％),全部清除65例(54.1％),再出血5例(4.1％).血肿全部清除者未发生明显的脑水肿,脑结构恢复较早较好.随访9个月～4年,GOS评分:恢复良好25例(20.8％),轻残20例(16.6％),中残37例(12.5％),重残23例(19.2％),死亡15例(12.5％).结论 应用显微技术小骨窗开颅手术治疗高血压壳核出血,创伤小,治疗效果好.
目的 迴顧性分析應用顯微技術小骨窗開顱手術治療高血壓殼覈齣血120例的治療效果,探討開顱手術的策略與技巧.方法 高血壓殼覈齣血120例,開顱手術,在距額骨顴突8 cm,圍繞外側裂的體錶線,額顳弧形切口,做直徑4 cm的骨窗,在中央前迴下點外側裂上緣無血管處前後方嚮切開皮層2～3 cm.用1 cm寬的腦闆分開至血腫腔清除血腫,然後在顯微鏡下操作,清除殘餘血腫,電凝止血.術後控製血壓,保持引流管通暢,12 h複查CT,評價手術效果.結果 血腫清除80％以上98例(82.0％),全部清除65例(54.1％),再齣血5例(4.1％).血腫全部清除者未髮生明顯的腦水腫,腦結構恢複較早較好.隨訪9箇月～4年,GOS評分:恢複良好25例(20.8％),輕殘20例(16.6％),中殘37例(12.5％),重殘23例(19.2％),死亡15例(12.5％).結論 應用顯微技術小骨窗開顱手術治療高血壓殼覈齣血,創傷小,治療效果好.
목적 회고성분석응용현미기술소골창개로수술치료고혈압각핵출혈120례적치료효과,탐토개로수술적책략여기교.방법 고혈압각핵출혈120례,개로수술,재거액골권돌8 cm,위요외측렬적체표선,액섭호형절구,주직경4 cm적골창,재중앙전회하점외측렬상연무혈관처전후방향절개피층2～3 cm.용1 cm관적뇌판분개지혈종강청제혈종,연후재현미경하조작,청제잔여혈종,전응지혈.술후공제혈압,보지인류관통창,12 h복사CT,평개수술효과.결과 혈종청제80％이상98례(82.0％),전부청제65례(54.1％),재출혈5례(4.1％).혈종전부청제자미발생명현적뇌수종,뇌결구회복교조교호.수방9개월～4년,GOS평분:회복량호25례(20.8％),경잔20례(16.6％),중잔37례(12.5％),중잔23례(19.2％),사망15례(12.5％).결론 응용현미기술소골창개로수술치료고혈압각핵출혈,창상소,치료효과호.
Objective To retrospectively analyze the treatment effect of craniotomy on 120 cases of hypertension putamen hemorrhage by microsurgical techniques with small bone window,and investigate the strategies and techniques of craniotomy.Methods One hundred and twenty cases of hypertensive putamen hemorrhage had craniotomy,at a distance of 8 cm from zygomatic process of the frontal bone,around the surface the lateral fissure lines,with frontotemporal curved incision,made a bone window of 2-4 cm in diameter,longitudinal incision with the diameter 2-3 cm were made on the no vessels edge of the cortex in the lower part of the central gyrus and top part of lateral fissure.The brain tissue was separated with 1 cm wide plates and the hematoma was removed,and then the residual hematoma was removed under the operating microscope,and the vessels were coagulated.Controlled the blood pressure and maintain drainage tube patency postoperatively,CT scan were made to evaluate surgical results after 12 hours.Results Hematomas were removed in more than 80％ of the 98 cases (82.0％),totally removed in 65 cases (54.1％),rebleeding in 5 cases (4.1％).Patients with hematoma totally removed showed no significant cerebral edema,brain structure restored earlier and better.Followed up for 9 months to 4 years,GOS score:good recovery in 25 cases (20.8％),mild disability in 20 cases (16.6％),moderate disability in 37 cases(12.5％),severe disability in 23 cases(19.2％),15 cases (12.5％) died.Conclusions The method to treat the hypertension putamen hemorrhage by microsurgical techniques with small bone window is feasible,with little trauma and better treatment effect.
