CAJ | 학술논문

目的：对比锥颅引流术与小骨窗开颅显微手术治疗高血压基底节区脑出血的临床疗效。方法回顾分析2006~2012年在我科治疗的126例高血压基底节区脑出血患者，其出血量在30~60 mL之间，其中60例患者在CT平片定位下锥颅软通道(即一次性使用颅脑外引流器)置管引流术，设为钻孔引流组，余66例患者行小骨窗开颅，显微镜下行血肿清除术，设为开颅组。观察两种不同方法治疗高血压脑出血的临床疗效。结果开颅组手术时间长于钻孔引流组(P<0.05)；两组术后并发症发生率及住院期间病死率无统计学意义(P>0.05)；钻孔引流组术后再出血率明显高于开颅组，出院随访3~6个月，开颅组日常生活能力(ADL)与钻孔引流组之间无明显差异(P>0.05)，但开颅组轻度残疾+无功能障碍为86.4%，而钻孔引流组为80.0%，开颅组优于钻孔引流组(P<0.05)。结论与锥颅软通道置管引流术相比，小骨窗开颅手术对基底节区中等量脑出血的治疗是一种高效、安全的手术方式。
목적：대비추로인류술여소골창개로현미수술치료고혈압기저절구뇌출혈적림상료효。방법회고분석2006~2012년재아과치료적126례고혈압기저절구뇌출혈환자，기출혈량재30~60 mL지간，기중60례환자재CT평편정위하추로연통도(즉일차성사용로뇌외인류기)치관인류술，설위찬공인류조，여66례환자행소골창개로，현미경하행혈종청제술，설위개로조。관찰량충불동방법치료고혈압뇌출혈적림상료효。결과개로조수술시간장우찬공인류조(P<0.05)；량조술후병발증발생솔급주원기간병사솔무통계학의의(P>0.05)；찬공인류조술후재출혈솔명현고우개로조，출원수방3~6개월，개로조일상생활능력(ADL)여찬공인류조지간무명현차이(P>0.05)，단개로조경도잔질+무공능장애위86.4%，이찬공인류조위80.0%，개로조우우찬공인류조(P<0.05)。결론여추로연통도치관인류술상비，소골창개로수술대기저절구중등량뇌출혈적치료시일충고효、안전적수술방식。
Objective To compare the clinical efficacy of trepanation and drainage with small bone window craniotomy microsurgical technique in the treatment of hypertensive cerebral hemorrhage in basal ganglia. Methods A total of 126 hypertensive patients with basal ganglia hemorrhage from 2006 to 2012 undergoing surgical treatment were retrospec-tively analyzed, the amount of hematoma was between 30-60 mL. 60 patients received trepanation and drainage in the guidance of the CT scan were as drainage group, another 66 cases of patients received small bone window craniotomy with microscopes were as craniotomy group. The clinical efficacy of the two different methods in the treatment of hyper-tensive intracerebral hemorrhage were observed. Results The operative time of craniotomy was much more longer than drainage group (P<0.05). There was no difference in incidence of postoperative complications and mortality during hos-pitalization (P>0.05). The postoperative rebleeding in drilling drainage group was significantly higher than the cran-iotomy group. The 3-6 months discharge follow-up showed that there was no difference in the activities of daily living (ADL) in craniotomy group and drill drainage group (P>0.05). But mild disabilities+no dysfunction group of craniotomy group (86.4%), which was higher than that of drainage group (80.0%) (P<0.05). Conclusion Compare with drilling drainage skills in treating hemorrhagic patients with medium hematoma, small bone window craniotomy is a safe and efficient surgical procedure.