2012
DOI: 10.1590/s0102-86502012001000010 View full text |Buy / Rent full text
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Abstract: PURPOSE: To compare curative effect of different treatments for hypertensive cerebral hemorrhage of 25 to 35ml. METHODS: In this study, 595 cases were enrolled and grouped regarding treatments including conservative treatment, evacuation with microinvasive craniopuncture technique within 6h and 6-48h after the attack. RESULTS: After follow up for three months after the attack, the assessment based on the Activity of Daily Living (ADL) indicated no significant difference among conservative treatment and surgica… Show more

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“…A similar study is presented by Zheng et al [29]. The authors analysed the data for 595 patients with BGH between 25-35 mL and compared cranio-puncture to conservative therapy.…”
Section: Discussionmentioning
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“…A similar study is presented by Zheng et al [29]. The authors analysed the data for 595 patients with BGH between 25-35 mL and compared cranio-puncture to conservative therapy.…”
Section: Discussionmentioning
“…Moreover, surgical procedures may increase the morbidity due to direct damage of brain structures [8]. Hence, minimally invasive treatment techniques arise as alternative surgical models for deep seated ICH with the goal of gently reducing the hematoma size and preventing secondary damage to the surrounding brain tissue (5,9,17,(23)(24)(25)(26)(27)(28)(29)(30)(31).…”
Section: Introductionmentioning
“…高血压脑出血是最常见的脑血管疾病,约占所有脑卒中的 30%~40% [7] ,可采用外科手术治疗和保守 治疗。对于手术适应证明确的患者,外科治疗效果优于内科治疗,已得到临床证实 [4,8,10,14] 。并且手术应早 期进行,这样可以及时清除血肿,有助于防止血肿扩大、减少毒性物质及炎性介质对周围脑组织的继发性 损伤,降低颅内压,改善血肿周围半暗区的神经功能,从而达到减少并发症、后遗症和改善预后的目的 [9] 。 目前,幕上出血量小于 10ml 者予以保守治疗,而血肿量大于 30ml 者应积极手术治疗,这一观点在临 床被普遍接受 [4,10] 。但是,目前对于出血量较少(<30ml)有明确神经功能障碍的高血压脑出血患者,是否 需要积极手术,还存在一定争议 [4~6, 10,14] 。有学者认为:血肿量偏小,不存在危重的颅内高压;经保守治疗, 血肿多可自行吸收;手术操作增加术后再出血的概率。所以不建议积极手术治疗 [11] 。但是,近来有研究发 现:血肿形成 30min 后,其周围的脑实质即发生海绵样变,6h 后紧靠血肿的脑实质开始出现坏死,坏死外 侧的脑组织内以静脉为主的小血管周围出现环状或片状出血灶, 到 12h 后坏死灶和血管外出血灶融合成片, 致使血肿周围脑组织由近及远的发生水肿、变性、出血和坏死 [12~14] 。此外,脑内血肿吸收分解时产生的凝 血酶、 5-羟色胺等有毒物质导致脑组织细胞缺血缺氧加重 [14,15] 。 更重要的是, 基底节区是锥体束必经之路, 一旦出血,即时是中少量血肿的形成,瘫痪、失语的发生概率极高。通过手术清除血肿,解除神经传导通 路的压迫及出血后继发性脑损伤,这也符合神经受压后早期减压的神经外科原则。基于以上观点,部分临 床医生认为:对于神经功能障碍明确的中少量基底节区出血应积极手术治疗,争取患者尽早的实现最大程 度的神经功能恢复 [8,14] 。本研究结果显示,早期手术治疗中少量高血压基底节区出血,并未引起患者术后 再出血;术后 2 周,显效到达 78.8%,好转 12.1%,手术效果显著,所以对于有明确神经功能障碍的中少量 高血压基底节区出血患者可早期积极手术干预。 目前高血压脑出血常用的开颅手术方法主要包括经颞中/上回入路血肿清除术、经侧裂-岛叶入路血肿 清除术 [4] 。两者各有优点:经颞叶皮层入路直接进入血肿腔,手术操作简单,进入血肿腔时间短;但颞中/ 上回是听觉性语言中枢所在区域(相当于 Brodmann41、42 区),颞叶深部有视辐射通过 [16] ,在此切开皮质 不可避免地会对以上结构造成损伤,并且此入路常因血肿显露困难,牵拉过度引起严重挫伤、水肿,所以 目前不少学者建议采取经侧裂-岛叶入路清除血肿 [4] 。外侧裂是大脑表面最明显、最恒定的定位标志,也是 一条天然的手术通道 [16] …”
Section: 讨论unclassified