Comparison between Skull Drill Drainage-urokinase Perfusion and Small Bone Flap Craniotomy for Removing the Hematoma in Hypertensive Cerebral Hemorrhage_West China Medical Journal

Authors：

ZHU Chengming ¹ , YAO Wenhua ¹ , WANG Guifu ² , ZHANG Deming ¹

1. Department of neurosurgery, People′s Hospital of Ya′an, Ya′an, Sichuan 625000, P. R. China; 2. Zunyi Medical College, Zunyi, Guizhou 563000,P.R.China;

Corresponding author：

Keywords：

血压脑出血; 脑外科手术; 开颅血肿清除术; 钻孔引流术; 疗效分析

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【摘要】　目的　比较钻孔引流尿激酶溶解术和小骨窗开颅术治疗高血压脑出血的疗效。　方法　 2008年9月-2009年12月分别接受钻孔引流尿激酶溶解术（A组，n=34）和小骨窗开颅术（B组，n=30）的高血压脑出血患者共64例（出血量30~50 mL，无脑疝），两组患者术前基线指标（如出血量、手术时机、昏迷程度等）比较无统计学意义。比较接受不同术式的两组患者手术时间、术后1个月的近期疗效、术后6个月远期疗效及死亡率。　结果　 A组手术时间短于B组，两组比较，有统计学意义（P lt;0.05）。术后1、6个月，A组疗效优于B组，两组比较，有统计学意义（P lt;0.05）。A、B组术后近期和远期死亡率比较，无统计学意义（P gt;0.05）。　结论　对出血部位在基底节区、出血量在30~50 mL，无脑疝的高血压脑出血患者，钻孔引流尿激酶溶解术的疗效明显优于小骨窗开颅术。
【Abstract】　Objective　 To compare the therapeutic effect of drill drainage-urokinase perfusion (group A) and small bone flap craniotomy on hypertensive intracerebral hemorrhage.　Methods　 A total of 64 patients with hypertensive intracerebral hemorrhage (about 30-50 mL) from September 2008 to December 2009 were collected. The patients underwent drill drainage-urokinase perfusion (group A,n=34) and small bone flap craniotomy (group B,n=30). The therapeutic effects, including operating time, short-term effect within one month, long-term effect six months after operation, operation time, and the rate of rehaemorrhagia and mortality were observed and the results of the two groups were compared.　Results　 The operation time was shorter in group A than that in group B (P lt;0.05); one month and six months after the operation, the therapeutic effects were better in group A than those in group B (P lt;0.05); the difference in mortality between the two groups was not significant (P gt;0.05).　Conclusion　 The therapeutic effect of drill draiage-urokinase perfusion is better than that of small bone flap craniotomy on the patients with hypertensive intracerebral hemorrhage in basal unclei with bleeding amount of 30-50 mL and without cerebralhern.

Citation： ZHU Chengming,YAO Wenhua,WANG Guifu,ZHANG Deming. Comparison between Skull Drill Drainage-urokinase Perfusion and Small Bone Flap Craniotomy for Removing the Hematoma in Hypertensive Cerebral Hemorrhage. West China Medical Journal, 2010, 25(11): 2035-2038. doi: Copy

1.	Tzaan WC, Lee ST, Lui TN. Combined used stereotacfic aspiration and intracerebral streptokinase infusion in the surgical treatment of hypertensive intracerebral hemorrhage[J]. Formos Med Assoc, 1997, 56(96): 962-967.
2.	陈祎阳, 焦德让. 高血压脑出血的外科治疗进展[J]. 中国老年病学杂志, 2006, 4(26): 566-567.
3.	Vanghan PJ, Pike CJ, Cotman CW, et al. thrombin Receptor activation protect neuron and astrocytes from cell death produced environmental insults [J]. Neuron Sci, 1995, 15(7) 5389-5401.
4.	脑卒中患者临床神经功能缺损程度评分标准(1995 年全国第四届脑血管病学术会议通过)[J]. 中华神经科杂志, 1996, 29 (6): 381-383.
5.	Jennett B, Bond M. Assessment of outcome after severe brain damage, a practical scale[J]. Lancet, 2005, 1(11): 480-483.
6.	王忠诚. 神经外科学[M]. 武汉: 湖北科学技术出版社, 2004: 867-874.
7.	Kobagashis, Sato A, Kageyamay, et al. Treatment of hypertensive Cerebral hemorrhage surgical or conservative management [J]. Neurosurgery, 1994, 34 (2): 246.
8.	Kingman TA, Mendelow AD, Graham DE, et al. Experimental intracerebral hemorrhage mass description of model intracranial pressure change and neuropathology [J]. Neuro pathol Exp Neurol, 1998, 47(2): 118-137.
9.	Rohde V, Rohde I, Reinges MHT, et al. Frameless stereotactically guided catheter placement and fibrinolytic therapy for sportaneous intracerebral hematomas: technique aspects and initial clinical results [J]. Minim Invasive Neurosurg, 2000, 43(1): 9-17.
10.	Xi G, Wagner KR, Keep RF, et al. Role of blood clod formation on early edema development after experimental intracerebral hemorrhage [J]. Stroke, 1992, 29 (12): 2580-2586.
11.	杨蜀莲, 李舜伟, 王国相, 等. 高血压动脉硬化性脑出血1003例分析[J]. 中华内科杂志, 1995, 20(3): 138.
12.	朱洪春, 唐仕芳. 高血压性脑出血3种治疗方法的疗效观察[J]. 重庆医学, 2004, 33(6): 825-826.
13.	Prasad K, Rrowan G, sirvastava A, et al. Surgery in primary supratentorial intracerebral hematoma: A meta-analysis of randomized trails[J]. Acta Neurol Scand, 1997, 95(6): 103-110.
14.	Batjier HH, Teisch JS, Allen BC, et al. Failure of surgery to improve outcome of hgpertensive hemorrhage[J]. Arch Newrol Scard, 1990, 47: 1100-1103.

1. 　Tzaan WC, Lee ST, Lui TN. Combined used stereotacfic aspiration and intracerebral streptokinase infusion in the surgical treatment of hypertensive intracerebral hemorrhage[J]. Formos Med Assoc, 1997, 56(96): 962-967.
2. 　陈祎阳, 焦德让. 高血压脑出血的外科治疗进展[J]. 中国老年病学杂志, 2006, 4(26): 566-567.
3. 　Vanghan PJ, Pike CJ, Cotman CW, et al. thrombin Receptor activation protect neuron and astrocytes from cell death produced environmental insults [J]. Neuron Sci, 1995, 15(7) 5389-5401.
4. 　脑卒中患者临床神经功能缺损程度评分标准(1995 年全国第四届脑血管病学术会议通过)[J]. 中华神经科杂志, 1996, 29 (6): 381-383.
5. 　Jennett B, Bond M. Assessment of outcome after severe brain damage, a practical scale[J]. Lancet, 2005, 1(11): 480-483.
6. 　王忠诚. 神经外科学[M]. 武汉: 湖北科学技术出版社, 2004: 867-874.
7. 　Kobagashis, Sato A, Kageyamay, et al. Treatment of hypertensive Cerebral hemorrhage surgical or conservative management [J]. Neurosurgery, 1994, 34 (2): 246.
8. 　Kingman TA, Mendelow AD, Graham DE, et al. Experimental intracerebral hemorrhage mass description of model intracranial pressure change and neuropathology [J]. Neuro pathol Exp Neurol, 1998, 47(2): 118-137.
9. 　Rohde V, Rohde I, Reinges MHT, et al. Frameless stereotactically guided catheter placement and fibrinolytic therapy for sportaneous intracerebral hematomas: technique aspects and initial clinical results [J]. Minim Invasive Neurosurg, 2000, 43(1): 9-17.
10. 　Xi G, Wagner KR, Keep RF, et al. Role of blood clod formation on early edema development after experimental intracerebral hemorrhage [J]. Stroke, 1992, 29 (12): 2580-2586.
11. 　杨蜀莲, 李舜伟, 王国相, 等. 高血压动脉硬化性脑出血1003例分析[J]. 中华内科杂志, 1995, 20(3): 138.
12. 　朱洪春, 唐仕芳. 高血压性脑出血3种治疗方法的疗效观察[J]. 重庆医学, 2004, 33(6): 825-826.
13. 　Prasad K, Rrowan G, sirvastava A, et al. Surgery in primary supratentorial intracerebral hematoma: A meta-analysis of randomized trails[J]. Acta Neurol Scand, 1997, 95(6): 103-110.
14. 　Batjier HH, Teisch JS, Allen BC, et al. Failure of surgery to improve outcome of hgpertensive hemorrhage[J]. Arch Newrol Scard, 1990, 47: 1100-1103.

West China Medical Journal

Comparison between Skull Drill Drainage-urokinase Perfusion and Small Bone Flap Craniotomy for Removing the Hematoma in Hypertensive Cerebral Hemorrhage

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