微创手术治疗高血压脑出血的评价及影响因素分析
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摘要
目的:初步探讨小骨窗开颅显微血肿清除术治疗高血压脑出血(HICH)的近期手术疗效(术后30d),客观评价此手术方式的优缺点。全面分析影响近期手术疗效的有关因素,初步制定出本术式治疗适应症,以提高手术效果。
方法:106例采取小骨窗显微血肿清除术治疗的HICH患者临床资料,包括年龄、性别、出血部位、血肿量、血肿形态、血肿破入脑室情况、发病至手术时间(T)、术前意识分级、GCS评分、平均动脉压(MAP)、血糖值、手术者、术后并发症、血肿复发率等14种因素。统计学分析各因素对近期手术疗效的影响,并从血肿清除率、再出血率、不同病情的死亡率、并发症发生率、手术安全性、住院时间及费用等方面,客观评价本术式的优缺点。结合统计学分析结果,分别对近期手术疗效有重要影响的因素进行讨论。
结果:本组血肿清除率79.3%,再出血率10.4%,并发症发生率25.5%,住院时间缩短。总体死亡率为27.4%(29/106),按术前意识状态分级,Ⅰ级无死亡、Ⅱ级15.4%、Ⅲ级14.3%、Ⅳ级28.6%、Ⅴ级64.0%。单因素分析:术前MAP、意识状态分级、GCS值、血肿形态、出血部位、血肿量、血肿是否破入脑室、血肿是否复发、及术后并发症等有统计学意义(P<0.05)。多因素Logistic回归分析:意识状态分级、术后并发症、出血部位有统计学意义(P<0.10)。
结论:小骨窗显微血肿清除术是一种较好的微创方法,其疗效确切,值得推广应用。意识状态分级、术后并发症、出血部位、GCS值、血肿形态、血肿量、血肿是否破入脑室、血肿是否复发等是影响近期手术疗效有的重要因素。其中,前3个最为重要,可作为评价本术式治疗HICH近期预后的重要指标。根据病人病情及CT表现选择手术方式、术中细致操作、术后精心管理是提高手术疗效及其安全性的关键。
Objective To primary investigate the early effect(in 30 days post operation) of hypertensive intracerebral hemorrhage(HICH) treated by microsurgery with small craniotomy, objective appraise the merits and defects of the procedure, and generally analyse the factors which influence operative effect, and primary draw the operation signs.Methods The clinic data of 106 patients suffering from HICH treated by microsurgery with small craniotomy, including age, sex, locations of hematoma, volume of hematoma, shape of hematoma, whether hematoma break into ventricle or not, time from illness onset to operation(T), consciousness state grade before operation, GCS, mean artery pressure(MAP), value of blood sugar, operators, complications post-operation, and hematoma recur, whose influence to early operative effect was analysed with statistic methods. Objective appraised the merits and defects of the procedure at the hematoma elimination rate, the rate of hematoma recur, the mortality in different grades of morbid state, the rate of complications happen, the operation security, the days in hospital, and the therapy charge. Combining with statistic results, analysed the factors which influence early operative effect, respectively.Results The hematoma elimination rate was 79.3%, the rate of hematoma recur was 10.4%, and complications rate was 25.5%, the days in hospital was less than before. The total mortality was 27.4% (29/106), grade Ⅰ had no death grade Ⅱ 15.4%, grade Ⅲ 14.3%, grade Ⅳ 28.6%, grade Ⅴ 64.0%. Univariate analysis results: MAP, GCS, consciousness state grade, shape of hematoma, locations of hematoma, volume of hematoma, whether hematoma break into ventricle or not, hematoma recur, and complications post-operation had statistic significance (P<0.05). Multivariate Logistic regression results: consciousness state grade, complications after operation, and locations of hematoma had statistic significance (P<0.10).Conclusions Microsurgery with small craniotomy is a better minimally invasive method, its effect is affirmative, and it deserves popularizing. Consciousness state grade, complications post-operation, locations of hematoma, GCS, shape of hematoma, volume of hematoma, whether hematoma break into ventricle or not, and hematoma recur are important factors which effect the prognosis, but anterior 3 factors are the most important indexes which we estimate the prognosis of HICH treated by microsurgery with small craniotomy. Strictly choosing patients according all factors before operation, carefully handling in operation, and exactly administrating patients after operation are pivotal to improve operative effect and security.
方法:106例采取小骨窗显微血肿清除术治疗的HICH患者临床资料,包括年龄、性别、出血部位、血肿量、血肿形态、血肿破入脑室情况、发病至手术时间(T)、术前意识分级、GCS评分、平均动脉压(MAP)、血糖值、手术者、术后并发症、血肿复发率等14种因素。统计学分析各因素对近期手术疗效的影响,并从血肿清除率、再出血率、不同病情的死亡率、并发症发生率、手术安全性、住院时间及费用等方面,客观评价本术式的优缺点。结合统计学分析结果,分别对近期手术疗效有重要影响的因素进行讨论。
结果:本组血肿清除率79.3%,再出血率10.4%,并发症发生率25.5%,住院时间缩短。总体死亡率为27.4%(29/106),按术前意识状态分级,Ⅰ级无死亡、Ⅱ级15.4%、Ⅲ级14.3%、Ⅳ级28.6%、Ⅴ级64.0%。单因素分析:术前MAP、意识状态分级、GCS值、血肿形态、出血部位、血肿量、血肿是否破入脑室、血肿是否复发、及术后并发症等有统计学意义(P<0.05)。多因素Logistic回归分析:意识状态分级、术后并发症、出血部位有统计学意义(P<0.10)。
结论:小骨窗显微血肿清除术是一种较好的微创方法,其疗效确切,值得推广应用。意识状态分级、术后并发症、出血部位、GCS值、血肿形态、血肿量、血肿是否破入脑室、血肿是否复发等是影响近期手术疗效有的重要因素。其中,前3个最为重要,可作为评价本术式治疗HICH近期预后的重要指标。根据病人病情及CT表现选择手术方式、术中细致操作、术后精心管理是提高手术疗效及其安全性的关键。
Objective To primary investigate the early effect(in 30 days post operation) of hypertensive intracerebral hemorrhage(HICH) treated by microsurgery with small craniotomy, objective appraise the merits and defects of the procedure, and generally analyse the factors which influence operative effect, and primary draw the operation signs.Methods The clinic data of 106 patients suffering from HICH treated by microsurgery with small craniotomy, including age, sex, locations of hematoma, volume of hematoma, shape of hematoma, whether hematoma break into ventricle or not, time from illness onset to operation(T), consciousness state grade before operation, GCS, mean artery pressure(MAP), value of blood sugar, operators, complications post-operation, and hematoma recur, whose influence to early operative effect was analysed with statistic methods. Objective appraised the merits and defects of the procedure at the hematoma elimination rate, the rate of hematoma recur, the mortality in different grades of morbid state, the rate of complications happen, the operation security, the days in hospital, and the therapy charge. Combining with statistic results, analysed the factors which influence early operative effect, respectively.Results The hematoma elimination rate was 79.3%, the rate of hematoma recur was 10.4%, and complications rate was 25.5%, the days in hospital was less than before. The total mortality was 27.4% (29/106), grade Ⅰ had no death grade Ⅱ 15.4%, grade Ⅲ 14.3%, grade Ⅳ 28.6%, grade Ⅴ 64.0%. Univariate analysis results: MAP, GCS, consciousness state grade, shape of hematoma, locations of hematoma, volume of hematoma, whether hematoma break into ventricle or not, hematoma recur, and complications post-operation had statistic significance (P<0.05). Multivariate Logistic regression results: consciousness state grade, complications after operation, and locations of hematoma had statistic significance (P<0.10).Conclusions Microsurgery with small craniotomy is a better minimally invasive method, its effect is affirmative, and it deserves popularizing. Consciousness state grade, complications post-operation, locations of hematoma, GCS, shape of hematoma, volume of hematoma, whether hematoma break into ventricle or not, and hematoma recur are important factors which effect the prognosis, but anterior 3 factors are the most important indexes which we estimate the prognosis of HICH treated by microsurgery with small craniotomy. Strictly choosing patients according all factors before operation, carefully handling in operation, and exactly administrating patients after operation are pivotal to improve operative effect and security.
引文
001.殷小平,张新江,姜亚平.脑出血颅内血肿抽吸引流治疗的现状[J].国外医学脑血管疾病分册,2002,10(1):40-42.
002.关俊文,刘茂健,吴华超,招康东.颅内血肿微创清除术治疗高血压脑出血104例的随机对照研究[J].广东医学院学报,2004,22(2):133-135.
003. Voland C, Serre CM, Delmas P. Platelet-osteosarcomacell interaction is mediated thought a specific fibrinbrinogen-binding sequence located with in the N-terminal domain of thrombospondin[J].J Bone Miner Res, 2000,15(2):361-368.
004.马英文,李辉,刘捷,马英,彭连栋.高血压脑出血血肿吸收吸收时间影响因素探察[J].中华神经医学杂志,2005,4(1):54-56.
005.邱继忠,范春明,韦凤媛.高血压脑出血微创治疗现状[J].中国综合临床,2003,19(5):391-392.
006.王建清,陈衔城,吴劲松,周蒙寅,徐福林.高血压脑出血手术时机的规范化研究[J].中国微侵袭神经外科杂志,2003,8(1):21-24.
007.吕宪民,冯凯,曹亦宾,吕艳华.不同方法治疗高血压脑出血81例[J].中国煤炭工业医学杂志,2004,7(3):263-264.
008.张建军,董伟峰,张俊,朱镇宇,顾水均,宣宏飞,谢仁龙,司云.高血压脑出血急诊分类归属对预后影响的研究[J].浙江创伤外科,2004,9(1):18-20.
009.何升雷.微创开颅经脑沟手术治疗高血压脑出血疗效观察[J].中国误诊学杂志,2005,5(2):263-264.
010.李毓生,赵艳,杨成宝.高血压脑出血手术时机与适应证的探讨[J].内蒙古民族大学学报(自然科学版),2004,19(2):225-227.
011. Gregson BA, Mendelow AD. International variations in surgical practice for spontaneousintracerebral hemorrhage[J]. Stroke, 2003, 34(11):2597-2598.
012.史玉泉.神经病学新理论新技术[M].上海:上海科学技术出版社,1998,第1版,257.
013.肖剑.外科治疗高血压脑出血临床疗效分析[J].长治医学院学报,2004,18(2):102-103.
014.侯为民,刘文强.微创颅内血肿清除技术治疗高血压脑出血临床应用[J].医师进修杂志(外科版),2004,27(1):37-38.
015.朱新臣,魏春华,石军峰,杨玉坤.超早期应用甘露醇对高血压性脑出血患者继续出血的影响[J].临床荟萃,2005,20(1):31-32.
016.叶敏,李劲松,龙舟.微创手术治疗高血压脑出血[J].立体定向和功能性神经外科杂志,2004,17(2):102-103.
017.黄波,陈冬妹,高添喜,伍爱平,刘勇,雷飞跃,张雪平.微创术治疗高血压脑出血36例临床分析[J].中国临床神经外科杂志,2004,9(1):70-71.
018.齐长柱,朱玉英,齐双福.微创穿刺术治疗高血压脑出血33例临床观察[J].重庆医学,2004,33(10):1460-1462.
019.章翔.脑卒中诊断治疗学[M].北京:人民军医出版社,2002,第1版,128-134.
020.陈润成,王合金,谭朝晖.微创清除术救治重症高血压脑出血的临床观察[J].临床神经病学杂志,2004,17(3):216-217.
021.毛群,勾俊龙.外科治疗脑出血回顾与展望[J].国外医学 神经病学 神经外科学分册,2003,5:420—422.
022.魏国平.32例高血压脑出血患者CT定向硬通道微创抽吸术[J].实用临床医学,2004,5(2):48-49.
023.林鹏,曹作为,金虎,陈焕雄,陈晓东,陈敏,颜山,李智勇,王小言.锁孔显微手术治疗高血压脑出血(附28例报告)[J].中国微侵袭神经外科杂志,2004,9(4):183.
024.张法云,李烨,泮临证,杨典定,陈晓.Y L-1型颅钻穿刺仪治疗高血压脑出血的研究[J].浙江创伤外科,2004,9(3):158-159.
025.黄光树,蒋万书.高血压脑出血外科治疗[J].实用医院临床杂志,2004,1(1):15-17.
026.王忠诚 主编.神经外科学[M].武汉:湖北科学技术出版社,2001,第2版,686-689.
027.马颖,程远.Y L-1型针穿刺碎吸术治疗高血压脑出血死亡原因分析[J].重庆医科大学学报,2004,29(4):526-528.
028.廖光查,覃刚,吴海春,毋强华.高龄高血压脑出血的超早期手术治疗效果观察[J].广西医学,2004,26(2):183-184.
029.徐道华.微创碎吸术治疗高血压脑出血62例临床分析[J].重庆医学,2004,33(10):1457-1458.
030.石金河,杨蕾,梁东良.微创穿刺术加尿激酶治疗超早期高血压脑出血[J].医师进修杂志(内科版),2004,27(4):46-47.
031.果春雨,金梅.微创颅内血肿清除术治疗幕上高血压脑出血临床观察[J].齐齐哈尔医学院学报,2004,25(5):525-526.
032.刘正敏.显微镜下小骨窗开颅清除血肿术治疗高血压脑出血[J].心脑血管病防治,2004,4(3):37-38.
033.潘荣南,罗云平,吴雪松,刘增庆.显微手术为主治疗高血压脑出血134例[J].广西医科大学学报,2004,21(2):265-266.
034.吴振宏.多针穿刺治疗60m l以上高血压脑出血30例报道[J].中风与神经疾病杂志,2004,21(3):264.
035.赵亚伟,杨卫山,何伯勇,王东,王琳.不同手术方法治疗幕上高血压脑出血早期疗效观察[J].中华神经外科杂志,2004,20(1):73.
036.冯家龙.高血压脑出血手术治疗方法探讨[J].重庆医学,2004,33(6):893-894.
037.宋洋,崔益钿,万青,蔡廷江,江小伟,王栋.高血压脑出血的外科治疗[J].中华神经外科疾病 研究杂志,2004,3(4):325-327.
038.高广伟,岳新灿,张剑宁.大骨瓣减压救治重型高血压脑出血的体会[J].中华神经外科疾病研究杂志,2004,3(3):273.
039.常斌鸽.微创方法与常规开颅血肿清除治疗高血压脑出血临床对照研究[J].中国疗养医学,2004,13(3):129-131.
040.刘德亮,王贤柱,区学明.高血压脑出血的微创术治疗[J].中国煤炭工业医学杂志,2004,7(1):56-57.
041.闫建萍,黄树华,林东,邱德胜.微刨颅内血肿清除术治疗重症高血压脑出血临床分析[J].适用神经疾病杂志,2005,8(2):43.
042.阮雨田,曲少华.高血压脑出血微创治疗应用体会[J].新疆医科大学学报,2004,27(2):184.
043.厉永伟,贺侠,李锋,张胜荣.脑出血微创颅内血肿清除治疗的研究[J].浙江临床医学,2004,6(3):163-164.
044.高添喜,黄波,伍爱平,林飞燕.微创术治疗高血压脑出血及其对神经功能早期康复的影响[J].中国康复医学杂志,2004,19(5):352-354.
045.吴立国,杨玉霞,高改云.微创颅内血肿清除术治疗中重度高血压脑出血63例报告[J].中风与神经疾病杂志,2004,21(3):261-262.
046.龚涛,易俊.微创清除与保守治疗高血压脑出血的效果比较[J].中国全科医学,2004,7(17):1255-1256.
047.胡新明,陈永健,张学军.颅内血肿的微创手术治疗[J].立体定向和功能性神经外科杂志,2002,15(4c):223-224.
048.常建波,黄雪松.高血压脑出血立体定向术后再出血原因分析[J].立体定向和功能性神经外科杂志,2002,13(1):49.
049.郭榜虎,姚惠芳,郝文光.电视内镜辅助行高血压脑出血血肿清除术治疗体会[J].浙江创伤外科,2004,9(4):270-271.
050.蒋正方,曾令勇,刘阳,李先全,吴贵强,唐克新,游潮.微创伤显微手术治疗高血压脑出血[J].川北医学院学报,2004,19(1):42-43.
051.左右,陈建良,吴耀晨,陈洪,吕文,郭伟.高血压脑出血小切口微创手术治疗[J].中国医师杂志,2004,6(5):580-582.
052.王春建,侯松玉,洪景芳,刘光,袁绍纪,张荣伟.显微锁孔开颅术治疗高血压脑出血[J].中华神经外科疾病研究杂志,2004,3(2):169-170.
053.蒋尊柏,雷厉,胡丹.早期微创手术治疗高血压脑出血[J].中国内科杂志,2004,6(2):254.
054.林忠,李英斌,张健.急诊微创手术治疗高血压脑出血[J].临床医学,2004,24(8):8-9.
055.王拥军.脑血管病急性期血压的管理[J].脑血管疾病杂志,2002,2(1):37-39.
056. Adams RE, Powers WJ. Management of hypertension in acute intracerebral hemorrhage[J]. Crit Care Clin, 1997, 13: 131-161.
057. Broderick JP, Adams HP Jr, Barsan W, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: astatement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association[J]. Stroke, 1999, 30: 905-915.
058. Kazui S, Minematsu K, Yamamoto H, et al. Predisposing factors to enlargement of spontaneous intracerebral hematomas[J]. Stroke, 1997, 28: 2370-2375.
059.耿志海,朱月.高血压脑出血影响疗效因素分析[J].中国误诊学杂志,2001,1(9):1319-1321.
060.杨瑞霞.微创技术治疗高血压脑出血患者出现继续出血的因素分析[J].临床荟萃,2004,19(7):395-396.
061.安贵群,许树元,刘宏亮.超早期微创开颅治疗高血压脑出血[J].实用临床医药杂志,2004,8(1):35-37.
062.梁启龙,魏世旺,刘凯,杨君,张弘,张莉.颅内血肿微创碎吸清除术临床分析.中华神经医学杂志,2005,4(2):178-180.
063.李建明,郑启平,黄思香.高血压脑出血后血肿扩大与血压的关系[J].中风与神经疾病杂志,2004,21(2):170.
064.马英文,彭连栋,马驰骋,李辉,刘捷.致高血压脑出血早期血肿扩大危险因素探讨[J].中国厂矿医学,2004,17(2):104-105.
065.柴湘婷,崔焕礼.复方丹参注射液治疗高血压脑出血临床疗效观察[J].中国基层医药,2003,10(12):1247-1248.
066.胡斌,王齐兰.灯盏花素治疗高血压脑出血32例疗效观察[J].实用中西医结合临床,2004,4(1)13-14.
067.刘洁,王鸣燕,张锐,于一.活血化瘀疗法对促进高血压脑出血血肿吸收的临床研究[J].中风与神经疾病杂志,2004,21(2):169-170.
068.周玉宝,王千,王国芳.不同剂量甘露醇对高血压脑出血患者颅内压及肾功能的影响[J].中国全科医学,2002,5(7):531-533.
069. Lee KR, Kawai N, Kim S, et al. Wechanisms of edema or marion after intracerebral hemorrhage: effects of thrombinon cerebral blood flow, blood-brain barrier permeability, and cell survival in a rat mode[J]. J Neurosurg, 1997, 86(2): 272-278.
070. Xi G, Wagner KR, Keep FR, et al. Role of blood clot for mationon on nearly edema development after experimental intracerebral hemorrhage[J]. Stroke, 1998, 29(12): 2580-2586.
071. Hickenbottom SL, Grotta JC, Strong R, et al. Nuclear factor-kappa-bell death after experimental intracerebral hemorrhage in rats[J]. Stroke, 1999, 30(11): 2472-2478.
072.赵雅度.关于“高血压脑出血手术时机的规范化研究”一文的述评[J].中国微侵袭神经外科杂志,2003,8(1):4.
073. Nenls DC, Mendelow AD, Crabam DI. Experimental intracerebral hemorrhage progression of hemodynamic changes after production of aspontameous mass lesion[J]. Neurosurg, 1998, 23: 439-444.
074. Rabinstein AA, Atkinson JL, Wijkicks EF, et al. Emergency craniotomy in patients worsening due to expanded cerebral hematoma: to what purpose?[J]. Neurology, 2002, 58(9): 1357-1372.
075. Siddique MS, Fernandes HM, Wooldridge TD. Reversible ischemia around intracerebral hemorrhage: a single-photon emission computerized tomography[J]. Neurosurgery, 2002, 96(4): 736-741.
076. Masada T, Hua Y, Xi G, et al. Attenuation of intracerebral hemorrhage and thrombininduced brain edema by overexpression of interleukin-1 receptor antagonist[J]. J Neurosurg, 2001, 95(4): 680-686.
077. Xi G, Hua Y, Keep RF, et al. Systemic complement depletion diminishes perihematomal brain edema in rats[J]. Stroke, 2001, 32(1): 162-167.
078. Huang FP, Xi G, keep RF, et al. Brain edema after experimental intracerebral hemorrhage: role of hemoglobin degradation products[J]. J Neurosurg, 2002, 96(2): 287-293.
079. Fisher CM. Hypertensive cerebral hemorrhage. Demonstration of the source of bleeding[J]. Neuropathol Exp Neurol, 2003, 62(1): 104-107.
080.张苏明,唐洲平.脑出血临床研究评价[J].中华神经外科杂志,2003,36(4):241-242.
081.单宝昌.高血压脑出血超早期微创治疗的基础与临床[J].中风与神经疾病杂志,2003,20(3):13-14.
082.王少兵,刘红朝,张光璞.112例高血压脑出血的手术治疗体会[J].中国医师杂志,2004,6(8):1124-1125.
083. Wangner KP, Xi G, Hua Y, et al. Ultraearly clot aspiration after lysis with tissue plasminogen activator in a porcine model of intracerebral hemorrhage: edema reduction and blood-brain barrier protection[J]. J Neurosurg, 1999, 90(3): 491-498.
084.张景杰.超早期小骨窗微创伤手术治疗高血压脑出血的疗效观察[J].职业与健康,2004,20(9):136-137.
085.姚振庆,程建铎.超早期微创手术治疗高血压脑出血的效果[J].齐鲁医学杂志,2004,19(3):211-212.
086.魏增华,续继军,李永涛,赵逢玲,吴超.高血压脑出血的规范化微创外科治疗[J].山东医药,2003,43(21):14-15.
087.陈家康.立体定向血肿排空术治疗高血压脑出血97例临床分析[J].右江民族医学院学报,2004,26(2):248-249.
088.林晓东,赵丽,王学敏,王海英,朱静,王虹.高血压脑出血微创术治疗的临床研究[J].中华神经医学杂志,2005,4(2):174-176.
089. Morgensterb LB, Demchuk AM, Kim DH. Rrbleeding leads to poor outcome in ultra-early craniotomy for intracerebral hemorrhage[J]. Neurology, 2001, 56(10): 1294-1299.
090.张振平,张春民.高血压脑出血超早期手术方法分析[J].医药论坛杂志,2004,25(4):37-38.
091. Fernandes HM, Gregson B, Siddique S, et al. Surgery in intracerebral hemorrhage[J]. Stroke, 2000, 31(10): 2511-2516.
092.赵勇刚.高血压脑出血微创清除手术时机研究[J].中国综合临床,2003,19(9):816-817.
093.黄盘冰,戴耀曾,汤备卫,陈瑛.微创术与碎吸术治疗重症高血压脑出血的对比研究[J].重庆医学,2004,33(10):1471-1472.
094.朱新洪,罗宗晚,胡继实,郭灿,杨焕送.内窥镜辅助高血压脑出血的微创手术治疗[J].中国内镜杂志,2004,10(7):34-38.
095.林宜生,洪湖强,刘炜,陈亿民,何君辉,林庭凯.去大骨瓣开颅超早期显微手术治疗重症高血压脑出血[J].中国急救医学,2004,24(5):369.
096.李亚平,贺桢令,王全,杨华,宋鑫.颅内血肿微创清除技术与小骨窗开颅手术治疗高血压脑出血临床对照分析[J].重庆医学,2004,33(10):1455-1457.
097.谢崇海,万金中.脑内镜CT立体定向手术治疗高血压脑出血[J].中华神经外科杂志,2001,17(2):200-201.
098.陈子卿,庄耀明,黄培昆.微创清除术治疗高血压脑出血71例疗效观察[J].中国危重病急救医学,2004,16(4):252.
099.贺震民,高艳珍,吴文,陈泽军,李镇,张君芳,柳嘉.微创碎吸术治疗高血压脑出血的临床研究[J].中华神经外科疾病研究杂志,2004,3(2):165-166.
100.林欣,杨玉山,只达石.显微手术治疗高血压脑出血102例[J].天津医药杂志,2004,32(8):500.
101.勾俊龙,毛群,邢复明,曾宪起,张毅,赵辉,刘宗惠.高血压脑出血立体定向治疗与开颅手术治疗预后对比分析[J].中华神经外科杂志,2004,20(5):425-428.
102.马东周,杨玲,郗振东,王红斌.高血压脑出血病情程度的标定方法[J].中国危重病急救医学,2004,16(4):251-252.
103.赵新军,杜勇健,魏琳,高培君,赵文卿,陈成勇.多因素量化预测高血压脑出血预后[J].神经疾病与精神卫生,2003,3(2):117-118.
104. Kaya RA, Turkmenoglu O, Ziyal IM. The effects on prognosis of surgical treatment of hypertensive putaminal hematomas through transsylvian transinsular approach[J]. Surg Neurol, 2003, 59(3): 176-183.
105.赵继宗.微创神经外科——理念和内容[J].中国医药新闻,2004,9(5):19.
106.杨辉.微创神经外科:现代神经外科的标志[J].第三军医大学学报,2003,25(20):1781-1783.
107.王忠诚.二十一世纪的神经外科学—微创神经外科学[J].中华神经外科杂志,2001,17(1):1-3.
108.郭良文,张雪山,李艳春.CT定位微侵袭穿刺治疗高血压脑出血[J].中国现代神经疾病杂志,2004,5(4):320-321.
109.中华神经科学会,中华神经外科学会.脑血管疾病分类及诊断[J].中华神经外科杂志,1997,13(1):34.
110.朱晓云,祝小燕,许志华.高血压脑出血微创血肿清除术后再出血的防治[J].江苏大学学报(医学版),2003,13(2):156-157.
111.杨晓阳,黄黛,黄英.脑出血微创术后死亡原因分析[J].中国误诊学杂志,2003,3(11):1701-1702.
112.岳术义,王铭维,冀学红.微创颅内血肿清除术治疗小量脑出血[J].临床荟萃,2005,20(5):271-273.
113. Fadrus P, Smrcka V, Svoboda T. Stereoraxic evacuation of spontaneous intracerebral hemorrhage with monitoring of intracerebral pressure[J]. Bratisl Lek Listy. 2004, 105(5-6): 325-239.
114.谢京城,王振宇,刘彬,马长城.小骨窗开颅显微手术治疗高血压性脑出血[J].中华显微外科杂志,2004,27(2):89-92.
115.田万管,黎檀石,苏忠,宝林,滕青山,沈洪.微创术治疗幕上高血压脑出血近期预后因素分析[J].第三军医大学学报,2003,25(17):1576-1578.
116.尹仲秋,陈隆益.早期小骨窗开颅治疗高血压脑出血36例[J].四川医学,2004,25(9):1000.
117.韦俊德,韦俊田.高血压脑出血手术预后的影响因素[J].广西医科大学学报,2003,20(2):260-261.
118.刘锋利.高血压脑出血的微创手术治疗[J].实用医学杂志,2005,21(6):595-596.
119.王忠诚 主编.神经外科学[M].武汉:湖北科学技术出版社,1998,第2版,687-689.
120.周良铺 主编.现代神经外科学[M].上海:复旦大学出版社,2001,第2版,801.
121.刘勇红,万琪,张光运,张志军,葛伟,薛福波.高血压脑出血患者30天预后的影响因素[J].中华老年心脑血管病杂志,2002,4(5):322-324.
122.吕明,王运华,吴中学.高血压脑出血手术治疗近期预后的影响因素[J].中国微侵袭神经外科杂志,2004,9(1):14-16.
123.张琥,王根绪,张庆华.锥颅穿刺血肿抽吸引流术治疗高血压脑出血临床研究[J].兰州医学院学报,2004,30(1):59-60.
124.郭希高,欧阳同伟,容耔耘.高血压脑出血超早期手术开颅小骨窗优选设计的临床研究[J].中华神经医学杂志,2005,4(2):161-163.
125.陈亿民.影响高血压脑出血术后预后因素临床分析[J].河北医学,2004,10(11):973-975.
126.陈永顺,甘鸿川,曹楚南.高血压脑出血合并双侧、第三脑室铸型的显微手术治疗[J].中华外科杂志,2003,41(9):719.
127.赵继宗.微创时代的神经外科[J].临床外科杂志,2004,12(1):25-27.
002.关俊文,刘茂健,吴华超,招康东.颅内血肿微创清除术治疗高血压脑出血104例的随机对照研究[J].广东医学院学报,2004,22(2):133-135.
003. Voland C, Serre CM, Delmas P. Platelet-osteosarcomacell interaction is mediated thought a specific fibrinbrinogen-binding sequence located with in the N-terminal domain of thrombospondin[J].J Bone Miner Res, 2000,15(2):361-368.
004.马英文,李辉,刘捷,马英,彭连栋.高血压脑出血血肿吸收吸收时间影响因素探察[J].中华神经医学杂志,2005,4(1):54-56.
005.邱继忠,范春明,韦凤媛.高血压脑出血微创治疗现状[J].中国综合临床,2003,19(5):391-392.
006.王建清,陈衔城,吴劲松,周蒙寅,徐福林.高血压脑出血手术时机的规范化研究[J].中国微侵袭神经外科杂志,2003,8(1):21-24.
007.吕宪民,冯凯,曹亦宾,吕艳华.不同方法治疗高血压脑出血81例[J].中国煤炭工业医学杂志,2004,7(3):263-264.
008.张建军,董伟峰,张俊,朱镇宇,顾水均,宣宏飞,谢仁龙,司云.高血压脑出血急诊分类归属对预后影响的研究[J].浙江创伤外科,2004,9(1):18-20.
009.何升雷.微创开颅经脑沟手术治疗高血压脑出血疗效观察[J].中国误诊学杂志,2005,5(2):263-264.
010.李毓生,赵艳,杨成宝.高血压脑出血手术时机与适应证的探讨[J].内蒙古民族大学学报(自然科学版),2004,19(2):225-227.
011. Gregson BA, Mendelow AD. International variations in surgical practice for spontaneousintracerebral hemorrhage[J]. Stroke, 2003, 34(11):2597-2598.
012.史玉泉.神经病学新理论新技术[M].上海:上海科学技术出版社,1998,第1版,257.
013.肖剑.外科治疗高血压脑出血临床疗效分析[J].长治医学院学报,2004,18(2):102-103.
014.侯为民,刘文强.微创颅内血肿清除技术治疗高血压脑出血临床应用[J].医师进修杂志(外科版),2004,27(1):37-38.
015.朱新臣,魏春华,石军峰,杨玉坤.超早期应用甘露醇对高血压性脑出血患者继续出血的影响[J].临床荟萃,2005,20(1):31-32.
016.叶敏,李劲松,龙舟.微创手术治疗高血压脑出血[J].立体定向和功能性神经外科杂志,2004,17(2):102-103.
017.黄波,陈冬妹,高添喜,伍爱平,刘勇,雷飞跃,张雪平.微创术治疗高血压脑出血36例临床分析[J].中国临床神经外科杂志,2004,9(1):70-71.
018.齐长柱,朱玉英,齐双福.微创穿刺术治疗高血压脑出血33例临床观察[J].重庆医学,2004,33(10):1460-1462.
019.章翔.脑卒中诊断治疗学[M].北京:人民军医出版社,2002,第1版,128-134.
020.陈润成,王合金,谭朝晖.微创清除术救治重症高血压脑出血的临床观察[J].临床神经病学杂志,2004,17(3):216-217.
021.毛群,勾俊龙.外科治疗脑出血回顾与展望[J].国外医学 神经病学 神经外科学分册,2003,5:420—422.
022.魏国平.32例高血压脑出血患者CT定向硬通道微创抽吸术[J].实用临床医学,2004,5(2):48-49.
023.林鹏,曹作为,金虎,陈焕雄,陈晓东,陈敏,颜山,李智勇,王小言.锁孔显微手术治疗高血压脑出血(附28例报告)[J].中国微侵袭神经外科杂志,2004,9(4):183.
024.张法云,李烨,泮临证,杨典定,陈晓.Y L-1型颅钻穿刺仪治疗高血压脑出血的研究[J].浙江创伤外科,2004,9(3):158-159.
025.黄光树,蒋万书.高血压脑出血外科治疗[J].实用医院临床杂志,2004,1(1):15-17.
026.王忠诚 主编.神经外科学[M].武汉:湖北科学技术出版社,2001,第2版,686-689.
027.马颖,程远.Y L-1型针穿刺碎吸术治疗高血压脑出血死亡原因分析[J].重庆医科大学学报,2004,29(4):526-528.
028.廖光查,覃刚,吴海春,毋强华.高龄高血压脑出血的超早期手术治疗效果观察[J].广西医学,2004,26(2):183-184.
029.徐道华.微创碎吸术治疗高血压脑出血62例临床分析[J].重庆医学,2004,33(10):1457-1458.
030.石金河,杨蕾,梁东良.微创穿刺术加尿激酶治疗超早期高血压脑出血[J].医师进修杂志(内科版),2004,27(4):46-47.
031.果春雨,金梅.微创颅内血肿清除术治疗幕上高血压脑出血临床观察[J].齐齐哈尔医学院学报,2004,25(5):525-526.
032.刘正敏.显微镜下小骨窗开颅清除血肿术治疗高血压脑出血[J].心脑血管病防治,2004,4(3):37-38.
033.潘荣南,罗云平,吴雪松,刘增庆.显微手术为主治疗高血压脑出血134例[J].广西医科大学学报,2004,21(2):265-266.
034.吴振宏.多针穿刺治疗60m l以上高血压脑出血30例报道[J].中风与神经疾病杂志,2004,21(3):264.
035.赵亚伟,杨卫山,何伯勇,王东,王琳.不同手术方法治疗幕上高血压脑出血早期疗效观察[J].中华神经外科杂志,2004,20(1):73.
036.冯家龙.高血压脑出血手术治疗方法探讨[J].重庆医学,2004,33(6):893-894.
037.宋洋,崔益钿,万青,蔡廷江,江小伟,王栋.高血压脑出血的外科治疗[J].中华神经外科疾病 研究杂志,2004,3(4):325-327.
038.高广伟,岳新灿,张剑宁.大骨瓣减压救治重型高血压脑出血的体会[J].中华神经外科疾病研究杂志,2004,3(3):273.
039.常斌鸽.微创方法与常规开颅血肿清除治疗高血压脑出血临床对照研究[J].中国疗养医学,2004,13(3):129-131.
040.刘德亮,王贤柱,区学明.高血压脑出血的微创术治疗[J].中国煤炭工业医学杂志,2004,7(1):56-57.
041.闫建萍,黄树华,林东,邱德胜.微刨颅内血肿清除术治疗重症高血压脑出血临床分析[J].适用神经疾病杂志,2005,8(2):43.
042.阮雨田,曲少华.高血压脑出血微创治疗应用体会[J].新疆医科大学学报,2004,27(2):184.
043.厉永伟,贺侠,李锋,张胜荣.脑出血微创颅内血肿清除治疗的研究[J].浙江临床医学,2004,6(3):163-164.
044.高添喜,黄波,伍爱平,林飞燕.微创术治疗高血压脑出血及其对神经功能早期康复的影响[J].中国康复医学杂志,2004,19(5):352-354.
045.吴立国,杨玉霞,高改云.微创颅内血肿清除术治疗中重度高血压脑出血63例报告[J].中风与神经疾病杂志,2004,21(3):261-262.
046.龚涛,易俊.微创清除与保守治疗高血压脑出血的效果比较[J].中国全科医学,2004,7(17):1255-1256.
047.胡新明,陈永健,张学军.颅内血肿的微创手术治疗[J].立体定向和功能性神经外科杂志,2002,15(4c):223-224.
048.常建波,黄雪松.高血压脑出血立体定向术后再出血原因分析[J].立体定向和功能性神经外科杂志,2002,13(1):49.
049.郭榜虎,姚惠芳,郝文光.电视内镜辅助行高血压脑出血血肿清除术治疗体会[J].浙江创伤外科,2004,9(4):270-271.
050.蒋正方,曾令勇,刘阳,李先全,吴贵强,唐克新,游潮.微创伤显微手术治疗高血压脑出血[J].川北医学院学报,2004,19(1):42-43.
051.左右,陈建良,吴耀晨,陈洪,吕文,郭伟.高血压脑出血小切口微创手术治疗[J].中国医师杂志,2004,6(5):580-582.
052.王春建,侯松玉,洪景芳,刘光,袁绍纪,张荣伟.显微锁孔开颅术治疗高血压脑出血[J].中华神经外科疾病研究杂志,2004,3(2):169-170.
053.蒋尊柏,雷厉,胡丹.早期微创手术治疗高血压脑出血[J].中国内科杂志,2004,6(2):254.
054.林忠,李英斌,张健.急诊微创手术治疗高血压脑出血[J].临床医学,2004,24(8):8-9.
055.王拥军.脑血管病急性期血压的管理[J].脑血管疾病杂志,2002,2(1):37-39.
056. Adams RE, Powers WJ. Management of hypertension in acute intracerebral hemorrhage[J]. Crit Care Clin, 1997, 13: 131-161.
057. Broderick JP, Adams HP Jr, Barsan W, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: astatement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association[J]. Stroke, 1999, 30: 905-915.
058. Kazui S, Minematsu K, Yamamoto H, et al. Predisposing factors to enlargement of spontaneous intracerebral hematomas[J]. Stroke, 1997, 28: 2370-2375.
059.耿志海,朱月.高血压脑出血影响疗效因素分析[J].中国误诊学杂志,2001,1(9):1319-1321.
060.杨瑞霞.微创技术治疗高血压脑出血患者出现继续出血的因素分析[J].临床荟萃,2004,19(7):395-396.
061.安贵群,许树元,刘宏亮.超早期微创开颅治疗高血压脑出血[J].实用临床医药杂志,2004,8(1):35-37.
062.梁启龙,魏世旺,刘凯,杨君,张弘,张莉.颅内血肿微创碎吸清除术临床分析.中华神经医学杂志,2005,4(2):178-180.
063.李建明,郑启平,黄思香.高血压脑出血后血肿扩大与血压的关系[J].中风与神经疾病杂志,2004,21(2):170.
064.马英文,彭连栋,马驰骋,李辉,刘捷.致高血压脑出血早期血肿扩大危险因素探讨[J].中国厂矿医学,2004,17(2):104-105.
065.柴湘婷,崔焕礼.复方丹参注射液治疗高血压脑出血临床疗效观察[J].中国基层医药,2003,10(12):1247-1248.
066.胡斌,王齐兰.灯盏花素治疗高血压脑出血32例疗效观察[J].实用中西医结合临床,2004,4(1)13-14.
067.刘洁,王鸣燕,张锐,于一.活血化瘀疗法对促进高血压脑出血血肿吸收的临床研究[J].中风与神经疾病杂志,2004,21(2):169-170.
068.周玉宝,王千,王国芳.不同剂量甘露醇对高血压脑出血患者颅内压及肾功能的影响[J].中国全科医学,2002,5(7):531-533.
069. Lee KR, Kawai N, Kim S, et al. Wechanisms of edema or marion after intracerebral hemorrhage: effects of thrombinon cerebral blood flow, blood-brain barrier permeability, and cell survival in a rat mode[J]. J Neurosurg, 1997, 86(2): 272-278.
070. Xi G, Wagner KR, Keep FR, et al. Role of blood clot for mationon on nearly edema development after experimental intracerebral hemorrhage[J]. Stroke, 1998, 29(12): 2580-2586.
071. Hickenbottom SL, Grotta JC, Strong R, et al. Nuclear factor-kappa-bell death after experimental intracerebral hemorrhage in rats[J]. Stroke, 1999, 30(11): 2472-2478.
072.赵雅度.关于“高血压脑出血手术时机的规范化研究”一文的述评[J].中国微侵袭神经外科杂志,2003,8(1):4.
073. Nenls DC, Mendelow AD, Crabam DI. Experimental intracerebral hemorrhage progression of hemodynamic changes after production of aspontameous mass lesion[J]. Neurosurg, 1998, 23: 439-444.
074. Rabinstein AA, Atkinson JL, Wijkicks EF, et al. Emergency craniotomy in patients worsening due to expanded cerebral hematoma: to what purpose?[J]. Neurology, 2002, 58(9): 1357-1372.
075. Siddique MS, Fernandes HM, Wooldridge TD. Reversible ischemia around intracerebral hemorrhage: a single-photon emission computerized tomography[J]. Neurosurgery, 2002, 96(4): 736-741.
076. Masada T, Hua Y, Xi G, et al. Attenuation of intracerebral hemorrhage and thrombininduced brain edema by overexpression of interleukin-1 receptor antagonist[J]. J Neurosurg, 2001, 95(4): 680-686.
077. Xi G, Hua Y, Keep RF, et al. Systemic complement depletion diminishes perihematomal brain edema in rats[J]. Stroke, 2001, 32(1): 162-167.
078. Huang FP, Xi G, keep RF, et al. Brain edema after experimental intracerebral hemorrhage: role of hemoglobin degradation products[J]. J Neurosurg, 2002, 96(2): 287-293.
079. Fisher CM. Hypertensive cerebral hemorrhage. Demonstration of the source of bleeding[J]. Neuropathol Exp Neurol, 2003, 62(1): 104-107.
080.张苏明,唐洲平.脑出血临床研究评价[J].中华神经外科杂志,2003,36(4):241-242.
081.单宝昌.高血压脑出血超早期微创治疗的基础与临床[J].中风与神经疾病杂志,2003,20(3):13-14.
082.王少兵,刘红朝,张光璞.112例高血压脑出血的手术治疗体会[J].中国医师杂志,2004,6(8):1124-1125.
083. Wangner KP, Xi G, Hua Y, et al. Ultraearly clot aspiration after lysis with tissue plasminogen activator in a porcine model of intracerebral hemorrhage: edema reduction and blood-brain barrier protection[J]. J Neurosurg, 1999, 90(3): 491-498.
084.张景杰.超早期小骨窗微创伤手术治疗高血压脑出血的疗效观察[J].职业与健康,2004,20(9):136-137.
085.姚振庆,程建铎.超早期微创手术治疗高血压脑出血的效果[J].齐鲁医学杂志,2004,19(3):211-212.
086.魏增华,续继军,李永涛,赵逢玲,吴超.高血压脑出血的规范化微创外科治疗[J].山东医药,2003,43(21):14-15.
087.陈家康.立体定向血肿排空术治疗高血压脑出血97例临床分析[J].右江民族医学院学报,2004,26(2):248-249.
088.林晓东,赵丽,王学敏,王海英,朱静,王虹.高血压脑出血微创术治疗的临床研究[J].中华神经医学杂志,2005,4(2):174-176.
089. Morgensterb LB, Demchuk AM, Kim DH. Rrbleeding leads to poor outcome in ultra-early craniotomy for intracerebral hemorrhage[J]. Neurology, 2001, 56(10): 1294-1299.
090.张振平,张春民.高血压脑出血超早期手术方法分析[J].医药论坛杂志,2004,25(4):37-38.
091. Fernandes HM, Gregson B, Siddique S, et al. Surgery in intracerebral hemorrhage[J]. Stroke, 2000, 31(10): 2511-2516.
092.赵勇刚.高血压脑出血微创清除手术时机研究[J].中国综合临床,2003,19(9):816-817.
093.黄盘冰,戴耀曾,汤备卫,陈瑛.微创术与碎吸术治疗重症高血压脑出血的对比研究[J].重庆医学,2004,33(10):1471-1472.
094.朱新洪,罗宗晚,胡继实,郭灿,杨焕送.内窥镜辅助高血压脑出血的微创手术治疗[J].中国内镜杂志,2004,10(7):34-38.
095.林宜生,洪湖强,刘炜,陈亿民,何君辉,林庭凯.去大骨瓣开颅超早期显微手术治疗重症高血压脑出血[J].中国急救医学,2004,24(5):369.
096.李亚平,贺桢令,王全,杨华,宋鑫.颅内血肿微创清除技术与小骨窗开颅手术治疗高血压脑出血临床对照分析[J].重庆医学,2004,33(10):1455-1457.
097.谢崇海,万金中.脑内镜CT立体定向手术治疗高血压脑出血[J].中华神经外科杂志,2001,17(2):200-201.
098.陈子卿,庄耀明,黄培昆.微创清除术治疗高血压脑出血71例疗效观察[J].中国危重病急救医学,2004,16(4):252.
099.贺震民,高艳珍,吴文,陈泽军,李镇,张君芳,柳嘉.微创碎吸术治疗高血压脑出血的临床研究[J].中华神经外科疾病研究杂志,2004,3(2):165-166.
100.林欣,杨玉山,只达石.显微手术治疗高血压脑出血102例[J].天津医药杂志,2004,32(8):500.
101.勾俊龙,毛群,邢复明,曾宪起,张毅,赵辉,刘宗惠.高血压脑出血立体定向治疗与开颅手术治疗预后对比分析[J].中华神经外科杂志,2004,20(5):425-428.
102.马东周,杨玲,郗振东,王红斌.高血压脑出血病情程度的标定方法[J].中国危重病急救医学,2004,16(4):251-252.
103.赵新军,杜勇健,魏琳,高培君,赵文卿,陈成勇.多因素量化预测高血压脑出血预后[J].神经疾病与精神卫生,2003,3(2):117-118.
104. Kaya RA, Turkmenoglu O, Ziyal IM. The effects on prognosis of surgical treatment of hypertensive putaminal hematomas through transsylvian transinsular approach[J]. Surg Neurol, 2003, 59(3): 176-183.
105.赵继宗.微创神经外科——理念和内容[J].中国医药新闻,2004,9(5):19.
106.杨辉.微创神经外科:现代神经外科的标志[J].第三军医大学学报,2003,25(20):1781-1783.
107.王忠诚.二十一世纪的神经外科学—微创神经外科学[J].中华神经外科杂志,2001,17(1):1-3.
108.郭良文,张雪山,李艳春.CT定位微侵袭穿刺治疗高血压脑出血[J].中国现代神经疾病杂志,2004,5(4):320-321.
109.中华神经科学会,中华神经外科学会.脑血管疾病分类及诊断[J].中华神经外科杂志,1997,13(1):34.
110.朱晓云,祝小燕,许志华.高血压脑出血微创血肿清除术后再出血的防治[J].江苏大学学报(医学版),2003,13(2):156-157.
111.杨晓阳,黄黛,黄英.脑出血微创术后死亡原因分析[J].中国误诊学杂志,2003,3(11):1701-1702.
112.岳术义,王铭维,冀学红.微创颅内血肿清除术治疗小量脑出血[J].临床荟萃,2005,20(5):271-273.
113. Fadrus P, Smrcka V, Svoboda T. Stereoraxic evacuation of spontaneous intracerebral hemorrhage with monitoring of intracerebral pressure[J]. Bratisl Lek Listy. 2004, 105(5-6): 325-239.
114.谢京城,王振宇,刘彬,马长城.小骨窗开颅显微手术治疗高血压性脑出血[J].中华显微外科杂志,2004,27(2):89-92.
115.田万管,黎檀石,苏忠,宝林,滕青山,沈洪.微创术治疗幕上高血压脑出血近期预后因素分析[J].第三军医大学学报,2003,25(17):1576-1578.
116.尹仲秋,陈隆益.早期小骨窗开颅治疗高血压脑出血36例[J].四川医学,2004,25(9):1000.
117.韦俊德,韦俊田.高血压脑出血手术预后的影响因素[J].广西医科大学学报,2003,20(2):260-261.
118.刘锋利.高血压脑出血的微创手术治疗[J].实用医学杂志,2005,21(6):595-596.
119.王忠诚 主编.神经外科学[M].武汉:湖北科学技术出版社,1998,第2版,687-689.
120.周良铺 主编.现代神经外科学[M].上海:复旦大学出版社,2001,第2版,801.
121.刘勇红,万琪,张光运,张志军,葛伟,薛福波.高血压脑出血患者30天预后的影响因素[J].中华老年心脑血管病杂志,2002,4(5):322-324.
122.吕明,王运华,吴中学.高血压脑出血手术治疗近期预后的影响因素[J].中国微侵袭神经外科杂志,2004,9(1):14-16.
123.张琥,王根绪,张庆华.锥颅穿刺血肿抽吸引流术治疗高血压脑出血临床研究[J].兰州医学院学报,2004,30(1):59-60.
124.郭希高,欧阳同伟,容耔耘.高血压脑出血超早期手术开颅小骨窗优选设计的临床研究[J].中华神经医学杂志,2005,4(2):161-163.
125.陈亿民.影响高血压脑出血术后预后因素临床分析[J].河北医学,2004,10(11):973-975.
126.陈永顺,甘鸿川,曹楚南.高血压脑出血合并双侧、第三脑室铸型的显微手术治疗[J].中华外科杂志,2003,41(9):719.
127.赵继宗.微创时代的神经外科[J].临床外科杂志,2004,12(1):25-27.