显微手术治疗幕上高血压性脑出血的体会

目的探讨显微镜下清除幕上高血压性脑出血的疗效。方法我院2010年1月-2013年1月显微手术治疗30例幕上高血压性脑出血，根据头颅CT影像定位确定手术切口，游离骨瓣开颅，做一长2-3am皮层瘘口，用自动牵开器由浅入深显露血肿，显微镜下清除血肿。结果30例手术均获得成功。术后次日复查头颅CT，14例血肿完全清除，11例血肿清除率达到90％，5例清除率达到80％。术后死亡4例（13．3％）：均于术后4周内死亡：2例死于脑疝所致脑干功能衰竭，1例死于肺部感染，1例死于多脏器功能衰竭。术后3个月ADL分级：I级7例，Ⅱ级9例，Ⅲ级6例，Ⅳ级3例，V级1例。结论显微镜下血肿清除并直视下止血，对脑组织损伤小，止血彻底，疗效满意。

Experience of Microsurgicai Operation in the Treatment of Supratentorial Hypertensive Intraeerebral Hemorrhage

Objective To explore the curative effects of microsurgical clearance for supratentorial hypertensive intracerebral hemorrhage. Methods A retrospective analysis of clinical data of 30 cases of supratentorial hypertensive intracerebral hemorrhage in our hospital from January 2010 to January 2013 was carried out. According to the head CT images, the position of incision was determined. Under orotracheal intubation general anesthesia, a bone flap craniotomy was performed. A cortex fistula 2 - 3 cm in length was made. Then by using an automatic retraction device, the hematoma was revealed from the shallower to the deeper, and microscopic clearance of hematoma was completed. Results All the 30 cases of operation were successful. Re-examination of head CT scans on the first postoperative day showed hematoma was completely removed in 14 cases, was 90% cleared in 11 cases, and 80% in 5 cases. Four patients died within 4 weeks after operation （ 13.3% ） ： 2 patients died of cerebral hernia caused by brainstem function failure, 1 patient died of lung infection, and 1 patient died of multiple organ failure. The postoperative survival rate was 86.7%. The ADL grade assessment 3 months after operation showed grade I in 7 cases, grade II in 9 eases, grade IH in 6 cases, grade IV in 3 cases, and grade V in 1 case. Conclusion Microscopic hematoma clearance and open haemostatic intervention has advantages of little brain tissue damage, good haemostatic results, and satisfactory efficacy.