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2464例高血压脑出血外科治疗多中心单盲研究

The efficacy of three different approaches in treatment of hypertensive intracerebral hemorrhage: a multi-center single-blind study of 2464 patients

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【作者】 赵继宗周定标周良辅王任直王德江王硕袁葛康帅赵元立季楠叶迅

【Author】 ZHAO Ji-zong*, ZHOU Ding-biao, ZHOU Liang-fu, WANG Ren-zhi, WANG De-jiang, WANG Shuo, YUAN Ge, KANG Shuai, ZHAO Yuan-li, JI Nan, YE Xun.*Department of Neurosurgery, Beijing Tiantan Hospital, Capital University of Medical Sciences, Beijing 100050,China

【机构】 首都医科大学附属北京天坛医院神经外科中国人民解放军总医院神经外科复旦大学附属华山医院神经外科北京协和医院神经外科首都医科大学附属北京天坛医院神经外科 100050100050

【摘要】 目的对比高血压脑出血的传统开颅、CT引导血肿吸引和微骨窗入路三种手术方法,分析手术疗效。方法2001年9月至2003年11月10日,国内135家医疗单位手术治疗2464例出血性脑卒中病例,完成3个月随访,采用多中心单盲研究方法比较不同手术方式疗效。结果2464例中传统组639例,微骨窗组409例,吸引组1416例。1个月累计病死率19.3%,3个月累计病死率21.1%。术前Glasgow昏迷评分(GCS)≤8分的病人,术后3个月病死率是GCS≥8分的3.5倍;术后有并发症者,术后3个月病死率是无并发症者的4.4倍;丘脑出血术后3个月病死率是皮层出血病人的2.4倍。3个月的病死率传统组(24.6%)高于微骨窗组(17.6%)和吸引组(20.6%)。三组间术后并发症,传统组(29.9%)与吸引组(24.8%)差异具有统计学意义(P=0.015)。结论微骨窗入路及CT引导吸引术组治疗高血压脑出血的手术病死率与致残率,以及预后的改善情况,优于传统开颅组。

【Abstract】 Objective To compare the efficacy and indications of the 3 approaches: conventional open craniotomy (COC), computed- tomography guided aspiration (CTGA), and key-hole approach (KHA) in neurosurgical management for hypertensive intracerebral hemorrhage (HICH). Methods The clinical data of HICH 2464 patients, aged 14-75, operated on within 24 hours after stroke, with a Glasgow coma score ≥5, hospitalized in 135 hospitals all over the mainland of China, were collected and underwent single-blind study. Results Among the 2464 patients 639 underwent COC, 1416 underwent CTGA, and 409 were operated on via KHA. The overall mortality rates within one and three months after operation were 19.3% and 21.1% respectively. The mortality rate within 3 months after operation (M3m) of the patient with a GCS≤8 was 3.5 times as much as the M3m of the patients with a GCS≥8. The M3m of the patients with complications was 4.4 times as much as that of the patients without complications. The M3m of the patients with hemorrhage in thalamus was 2.4 times as much as that of the patients with cortical hemorrhage. The M3m of the COC group was 24.6%, higher than those of the KHA group (17.6%) and CTGA group (20,6%). The postoperative complication rate of the COC group was 29.9%, significantly higher than that of the CTGA group (24.8%, P=0.015). There were no significant differences in postoperative complication rate between the COC and KHA groups and between the CTGA and KHA groups (both P>005). Conclusion KHA and CTGA are both better than COC in treatment of HICH with more favorable outcome and less postoperative mortality and morbidity.

【关键词】 颅内出血,高血压性; 微创神经外科; 颅骨切开术; CT引导吸引术; 微骨窗入路;

【Key words】 Intracranial hemorrhage,hypertensive; Minimally invasive neurosurgery; Craniotomy; Computed tomography guided aspiration; Key-hole approach;

【分类号】R743.4;R181.24;R651.1;

【基金】 国家“十五”科技攻关课题基金资助项目(2001BA703B16)

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