周元鼓+黄光否+黄启稳+廖国俏��

【摘要】目的对比分析脑立体定向血肿穿刺抽吸术与开颅血肿清除术治疗高血压脑出血（HICH）的临床疗效。

方法选择2012年5月至2016年9月采用立体定向血肿穿刺抽吸术治疗的60例HICH患者作为立体定向组，另选同期开颅血肿清除术治疗的60例HICH患者作为开颅手术组，比较两组患者手术耗时、术中失血量、住院时间、并发症发生情况、GCS评分及ADL分级。

结果立体定向组患者手术耗时、住院时间、术中失血量均较开颅手术组明显减少，术后3 d、术后1周时GCS评分明显高于开颅手术组，术后6个月时ADL分级明显优于开颅手术组，差异有统计学意义（P<0.05）。立体定向组并发症发生率为8.33%，明显低于开颅手术组的23.33%（P<0.05）。

结论脑立体定向血肿穿刺抽吸术治疗高血压脑出血疗效确切、创伤小、并发症少。

【关键词】立体定向；血肿穿刺抽吸术；开颅手术；高血压脑出血

中图分类号：R743.34文献标识码：ADOI：10.3969/j.issn.10031383.2017.02.019

【Abstract】ObjectiveTo compare and analyze clinical effects of stereotactic hematoma aspiration and craniotomy evacuation of hematoma for hypertensive cerebral hemorrhage（HICH）.

Methods60 HICH patients who underwent stereotactic hematoma aspiration from May，2012 to September，2016 were selected as stereotactic group，60 HICH patients who underwent stereotactic hematoma during the same period were selected as craniotomy group.And then，operation time，intraoperative hemorrhage，hospital stays，complications，GCS scores and ADL grades were compared between the two groups.

ResultsThe operation time，the hospital stays and the intraoperative hemorrhage of the stereotactic group were significantly less than those of the craniotomy group，the GCS score of the stereotactic group was significant higher than that of the craniotomy group three days and one week after operation，and the ADL grade of the stereotactic group was significantly superior to that of the craniotomy group six months after operation，so difference was statistically significant（P<0.05）.Incidence of complications of the stereotactic group was 8.33%，significantly lower than that （23.33%） of the craniotomy group（P<0.05）.

ConclusionStereotactic hematoma aspiration has the characteristics of good efficacy，small injury and few complications in the treatment of hypertensive cerebral hemorrhage.

【Key words】stereotaxis；hematoma aspiration；craniotomy；HICH

高血壓脑出血（hypertensive intracerebal hemarrhage，HICH）是一种临床常见且严重危害人类健康的神经外科急症，病死率和致残率均较高，即使能挽救生命也很容易引起失语、肢体瘫痪、智障等后遗症[1]。传统HICH治疗多采用开颅血肿清除手术，创伤大、并发症多，对于伴有其他严重并发症的患者更是无法耐受。近年来随着微侵袭神经外科与影像学技术的发展，立体定向手术在HICH的治疗中逐渐得到应用，为HICH的治疗提供了一种新途径。本文就我院采用脑立体定向血肿穿刺抽吸术与开颅血肿清除术治疗HICH的效果进行对比分析，为HICH的临床治疗选择提供参考，报告如下。……