目的 分析小骨窗开颅、钻孔引流术和骨瓣开颅三种手术方式治疗高血压脑出血的临床疗效和安全性.方法 选取该院神经外科2012年6月至2015年2月收治的280例患有高血压脑出血且行手术治疗的患者作为研究对象,回顾性分析其临床资料,其中采用小骨窗开颅术的有90例,采用锥颅钻孔引流术的有110例,而采用骨瓣开颅术的有80例.统计并分析三组患者的存活率和远期临床疗效.结果 三组患者在住院期间共有58例死亡,其生存率为79.3%.小骨窗开颅术组、锥颅钻孔引流术组、骨瓣开颅术组的生存率分别为73.3%、78.2%、87.5%,比较差异无统计学意义(P>0.05);小骨窗开颅术组、锥颅钻孔引流术组、骨瓣开颅术组愈合率分别为57.2%、58.7%、30.1%.小骨窗开颅术组和锥颅钻孔引流术组患者的愈合率明显大于骨瓣开颅术组,差异有统计学意义(P<0.05);治疗6周后,锥颅钻孔引流术组和骨瓣开颅术组的患者临床疗效明显高于小骨窗开颅术组;治疗后12周,锥颅钻孔引流术组和骨瓣开颅术组的神经功能缺损评分明显低于小骨窗开颅术组,差异均有统计学意义(P<0.05);小骨窗开颅术组患者手术时长明显长于锥颅钻孔引流术组和骨瓣开颅术组,小骨窗开颅术组患者术中输血量、术后切口脑脊液渗漏发生概率和住院时长均明显少于锥颅钻孔引流术组和骨瓣开颅术组患者,差异均有统计学意义(P<0.05).结论 小骨窗开颅术、锥颅钻孔引流术和骨瓣开颅术清除患者脑内血肿时具有不同的临床疗效,可不同程度提高患者生存率和预后.
Objective To analyze the clinical effects and safety in three surgical methods of small bone window craniotomy,drill-ing drainage and skull-flap craniotomy for treating hypertension cerebral hemorrhage.Methods Two hundreds and eighty cases of hypertension cerebral hemorrhage treated by operation in the neurosurgery department of the hospital from June 2012 to February 2015 were selected as the research subjects and their clinical data were retrospectively analyzed,including 90 cases of small bone window craniotomy,110 cases of drilling drainage and 80 cases of skull-flap craniotomy.The survival rate and long-term clinical curative effects in these three groups were statistically analyzed.Results Among 3 groups,58 cases died during hospitalization peri-od.The survival rate was 79.3%,which of the small bone window craniotomy group,skull drilling drainage group and skull-flap craniotomy group were 73.3%,78.2% and 87.5%,the difference had no statistical significance(P>0.05);the healing rates of the small bone window craniotomy group,skull drilling drainage group and skull-flap craniotomy group were 57.2%,58.7% and 30.1% respectively,the healing rate of the small bone window craniotomy surgery group and skull drilling drainage group was sig-nificantly higher than that of skull-flap craniotomy group,the difference was statistically significant(P<0.05);the clinical effects after 6 weeks of treatment in the skull drilling drainage group and skull-flap craniotomy group were significantly higher than that in the small bone window craniotomy group;the nerve function defect scores after 12 weeks of treatment in the skull drilling drainage group and skull-flap craniotomy group were significantly lower than that in the small bone window craniotomy group,the difference was statistically significant(P<0.05);the operative time in the small bone window craniotomy group was significantly longer than that in the skull drilling drainage group and skull-flap craniotomy group,the difference was statistically significant(P<0.05),while the intraoperative blood infusion amount,occurrence probability of postoperative incision cerebrospinal fluid leakage and hospitaliza-tion duration in the small bone window craniotomy group were significantly less than those in the skull drilling drainage surgery group and skull-flap craniotomy group,the difference was statistically significant(P<0.05).Conclusion Small bone window crani-otomy,skull drilling drainage and skull-flap craniotomy in clearing cerebral hematoma have different clinical effects,can improve the patient′s survival rate and prognosis in varying degrees.