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1、#93#中华显微外科杂志2004年5月第27卷第2期ChinJMicrosurg,May,2004,Vol27,No12#神经外科显微手术#合并脑疝的高血压基底节区脑出血的显微外科手术治疗许海雄罗友章李克民张志宏方旭生林恩郭骅刘明发张增良孙德麟=摘要>目的探讨应用显微外科手术治疗高血压基底节区脑出血并脑疝的方法和临床疗效。方法对高血压基底节区脑出血并脑疝病例,采用额颞部骨窗开颅,去骨瓣减压,微创皮层造瘘,在手术显微镜下进行清除脑内血肿和止血。术后追踪6个月,采用功能独立性测定(FIM)进行脑卒中患者日常生活活动能力(ADL)的评定。结果60例中,死亡9例,死亡率15%。术后随访6~
2、24个月,失访1例,对存的活50例根据FIMofADL进行评定,结果其中完全独立3例,基本独立4例,极轻度依赖绝大部分独立5例,轻度依赖大部分独立12例,中度依赖小部分独立15例,重度依赖4例,极重度依赖3例,完全依赖4例。结论采用额颞部骨窗开颅,微创皮层造瘘,就显微镜下清除脑内血肿和止血的方法,是治疗高血压基底节区脑出血并脑疝的有效方法之一。=关键词>基底节区脑出血;脑疝;显微外科手术MicrosurgicaltreatmentforhypertensivebasalgangliahemorrhagecomplicatedcerebralherniationXUHai-xiong
3、,LUOYou-zhang,LIKe-minZHANGZhi-hong,FANGXu-sheng,LINEn,GUOHua,LIUMing-fa,ZHAHGZeng-liang,SUNDe-lin1DepartmetofNeurosurgery,CentralHospitalofGuangdongShantou,Shantou515031,China=Abstract>ObjectiveTostudythemethodsandcurativeeffectofmicrosurgerytreatmenthypertensivebasalgangliahemorrhagecomplica
4、tedcerebralherniation1MethodsTransfrontotemporalcraniotomy,largedecompres-sivecraniotomies,cortexstomaismadebyminimallyinvasivetechnique,removeintracranialhematomandwithhold-ingbleedingundermicroscopeon60patientsofhypertensivebasalgangliahemorrhagecomplicatedcerebralhernia-tion1Thenfollow-up6~
5、24monthsaftertheoperation,evaluateactivitiesofdailyliving(ADL)byfunctionalinde-pendencemeasure(FIM)1ResultsNinepatientsdiedamong60cases,fatalitywas15%1Afteroperationtherewere18casescomplicatedgastrointestinalbleeding,37casescomplicatedlunginfection,3casesweremultipleorganfailure1Follow-up6~24m
6、onths,1casewaslosed,3patientsshowedcompletelyindependence,4patientsshowedessentialindependence,5patientsneedextrememild-dependence,12patientsneedmild-dependence,15patientsneedmoderate-dependence,4patientsneedsevere-dependence,3patientsneedextremesevere-dependenec,4pa-tientsneedcompletelydepend
7、ence1ConclusionTransfrontotemporalcraniotomy,largedecompressivecran-iotomies,cortexstomaismadebyminimallyinvasivetechnique,removeintracranialherniationandwithholdingbleedingundermicroscopeareaneffectivetreatmentforhypertensivebasalgangl
