颅骨钻孔引流术与开颅手术治疗高血压脑出血的疗效分析
|
摘要
目的：比较颅骨钻孔引流术与开颅手术治疗高血压脑出血(hypertensive intracerebral hemorrhage，HICH)的优缺点及疗效，为临床选用合适手术方式提供依据。
方法：回顾性分析2010年至2012年于我院手术治疗的85例高血压脑出血病人的资料，其中采用骨瓣开颅血肿清除术组40例，颅骨钻孔引流术组45例。术前对两组病例的一般特征(性别、年龄)、神经功能缺损程度、血肿量、出血位置、手术时机等进行均衡性比较。按照1995年第四届脑血管病学术会议研究通过的神经功能缺损评分标准，对患者的神经功能缺损情况及病情的轻重进行评估。评分总共45分，缺损越重，患者评分越高，轻型为0至15分，中型为16至30分，重型为31至45分。比较两种手术方法治疗后一个月患者神经功能缺损程度、并发症发生率、病死率、术后再出血发生率、手术时间等指标的差别。
结果：
1对开颅组及钻孔组患者在年龄、性别、出血部位、出血量、治疗前临床神经功能缺损程度评分、手术时机等一般情况进行均衡性检验没有统计学差异，具有可比性。
2手术前后两组组内比较，术后一个月临床神经功能缺损程度评分均较术前有明显降低，有统计学的差异。术后两组间临床神经功能缺损程度，轻型组间比较及中型组间比较，有统计学差异（p<0.05）；重型组间比较，无统计学差异（p>0.05）。钻孔引流术对于改善轻型及中型患者神经功能缺损程度优于开颅手术，但对于重型患者二者没有统计学的差异。
3不同出血量手术前后两组组内比较，术后临床神经功能缺损程度评分均较术前有明显降低，有统计学的差异（p<0.05）。术后两组间临床神经功能缺损程度，血肿量≤40ml组间比较及40ml <血肿量≤60ml组间比较，有统计学的差异（p<0.05）；血肿量>60ml组间比较，无统计学的差异（p>0.05）。钻孔引流术对血肿量≤60ml患者，改善神经功能缺损程度优于开颅手术。但对血肿量>60ml患者二者没有统计学的差异。
4并发症发生情况比较，开颅组肺部感染发生率35％，消化道出血发生率18％；钻孔组肺部感染发生率18％，消化道出血发生率9％，两组病人并发症发生率有统计学的差异（p<0.05）。
5不同手术方法病死率的比较：开颅组病死率20％，钻孔组病死率20％，两组病人病死率无统计学的差异（p>0.05）。
6开颅组与钻孔组术后再出血率比较：开颅组术后再出血率5％，钻孔组术后再出血率18％，两组病人再出血发生率有统计学的差异（p<0.05）。
7两组平均手术时间、血肿消失时间比较。开颅组平均手术时间为149.7±10.9min，首次血肿清除量约76.1±8.2(％)；钻孔组平均手术时间为36.2±11.3min，首次血肿清除量约39.9±7.6(％)，有统计学的差异（p<0.05）。
结论：
1开颅手术和钻孔引流术对治疗高血压脑出血有效，术后神经功能缺损程度较术前减轻。
2病情分级与疗效紧密相关，术前神经功能缺损程度越重，预后越差。术前神经功能缺损程度为中型组患者预后好于术前重型组，而术前轻型组预后又好于术前中型组。对于术前轻型组和中型组患者，钻孔引流术对于改善神经功能缺损程度优于开颅手术，但对于重型患者二者没有统计学差异。
3出血量越大临床神经功能缺损程度越重，手术后患者预后也越差。对于幕上血肿量≤60ml患者，钻孔引流术改善神经功能缺损程度优于开颅手术。但对于幕上血肿量>60ml患者二者没有统计学差异。
4开颅手术首次血肿清除量明显多于钻孔引流术，开颅术手术时间长，平均手术时间明显高于钻孔术。开颅手术并发症发生率高于钻孔术。钻孔术再出血发生率高于开颅术。开颅术与钻孔术的患者病死率没有统计学差异。
Purpose: To compare the advantages and disadvantages and curative effectof drilling drainage operation and craniotomy in the treatment of HICH,provide the basis evidence for the clinical choice of appropriate surgicalapproach.
Methods: Retrospective analysis85cases of HICH patient informationfrom2010to2012in our hospital, bone flap craniotomy group are40cases,skull drilling drainage group45cases. Preoperation, we compared the generalcharacteristics(sex, age), the degree of neurological deficits, the amount ofbleeding, the bleeding site, and the opportunity of surgery about the twogroups. According the evaluation standard in the fourth academic conferenceon cerebral vascular disease, evaluate patients’ situation of neurologicalimpairment and the severity of the disease. There is a total of45scores. Theheavier impairment is, the higher scores are. Light degree is0-15scores.Middle degree is16-30scores.Serious degree is31-45scores. The factors ofneurological impairment, complication incidence, fatality rate, rebleedingrate，operation time between the two groups after treatment for one monthwere compared.
Results：
1There were no statistical differences between the two groups in thefollowing factors，including age,general characteristics，the bleeding site, theamount of bleeding, degree of neurological deficits before treatment and thetiming of surgery.
2One month after operation, the scores of neurological impairment degree inboth groups are lower than preoperation. p<0.05, There was statisticaldifference. Comparision the neurological impairment between craniotomy anddrilling drainage after operation, p<0.05in light degree group and middle degree group,.There was statistical difference. And the neurologicalimpairment between craniotomy and drilling drainage after operation, p>0.05.There was no statistical difference. Drilling drainage operation is moreeffective for improving the degree of neurological deficits for light degreepatients and middle degree patients. But there was no statistical difference inthe treatment of severe degree patients.
3The scores of neurological impairment degree after surgery in both groupsare lower than preoperation in different amount of bleeding. p<0.05, Therewas statistical difference. After operation, the degree of neurologicalimpairment between craniotomy and drilling drainage has statistical difference,both in hematoma volume less than40ml group and between40to60ml group.p<0.05. But in hematoma volume more than60ml group, p>0.05, There wasno statistical difference. Drilling drainage operation is more effective forimproving the degree of neurological deficits for the patients whose hematomavolume was less than60ml. There was no statistical difference in treatmentfor the patients whose hematoma volume was more than60ml.
4There was statistical difference between the two groups in the incidence ofpulmonary infection and gastrointestinal bleeding during hospital.For thepulmonary infection, drilling drainage operation group is18%，craniotomygroup is35%. And for the gastrointestinal,drilling drainage operation group is9%，craniotomy group is18%.
5There was no statistical difference between the two groups in the fatality rateduring hospital，Drilling drainage operation group is20%，craniotomy groupis20%.
6There was statistical difference between the two groups in the rebleedingrate during hospital. Drilling drainage operation group is18%，craniotomygroup is5%.
7The average operation time of drilling drainage operation group is36.2±11.3min，and for craniotomy group,it’s149.7±10.9min. There was statisticaldifference between two groups. The first volume of hematoma in drillingdrainage operation group is39.9±7.6(％)，which in craniotomy group is 76.1±8.2(％).There was statistical difference between two groups.
Conclutions:
1Craniotomy and drilling drainage are effective in treating HICH. The degreeof neurologic impairment after surgery is lower than preoperation.
2Disease classification is closely related to efficacy. Clinical neurologicaldeficit is more severe, the prognosis is worse. The patients who are in middledegree group preoperative have a better prognosis than serious degree group.And light degree group are better than middle group. For the patients who isbelong to light degree group or middle group, drilling drainage is moreeffective for improving the degree of neurological deficits. But there was nostatistical difference in treatment of severe patients.
3The amount of bleeding is more great, the clinical neurological deficit ismore severe. The prognosis of patients after surgery is worse. The patientswhose hematoma volume was less than60ml, drilling drainage is moreeffective for improving the degree of neurological deficits. There was nostatistical difference in treatment for the patients whose hematoma volumewas more than60ml.
4Craniotomy can remove more hematoma than drilling drainage operation forthe first time. The average time of craniotomy was longer than drillingdrainage operation. The complication rate of Craniotomy is higher than thedrilling drainage operation. The rebleeding rate of Craniotomy was higherthan drilling technique. There was no statistical difference in fatality rate.
方法：回顾性分析2010年至2012年于我院手术治疗的85例高血压脑出血病人的资料，其中采用骨瓣开颅血肿清除术组40例，颅骨钻孔引流术组45例。术前对两组病例的一般特征(性别、年龄)、神经功能缺损程度、血肿量、出血位置、手术时机等进行均衡性比较。按照1995年第四届脑血管病学术会议研究通过的神经功能缺损评分标准，对患者的神经功能缺损情况及病情的轻重进行评估。评分总共45分，缺损越重，患者评分越高，轻型为0至15分，中型为16至30分，重型为31至45分。比较两种手术方法治疗后一个月患者神经功能缺损程度、并发症发生率、病死率、术后再出血发生率、手术时间等指标的差别。
结果：
1对开颅组及钻孔组患者在年龄、性别、出血部位、出血量、治疗前临床神经功能缺损程度评分、手术时机等一般情况进行均衡性检验没有统计学差异，具有可比性。
2手术前后两组组内比较，术后一个月临床神经功能缺损程度评分均较术前有明显降低，有统计学的差异。术后两组间临床神经功能缺损程度，轻型组间比较及中型组间比较，有统计学差异（p<0.05）；重型组间比较，无统计学差异（p>0.05）。钻孔引流术对于改善轻型及中型患者神经功能缺损程度优于开颅手术，但对于重型患者二者没有统计学的差异。
3不同出血量手术前后两组组内比较，术后临床神经功能缺损程度评分均较术前有明显降低，有统计学的差异（p<0.05）。术后两组间临床神经功能缺损程度，血肿量≤40ml组间比较及40ml <血肿量≤60ml组间比较，有统计学的差异（p<0.05）；血肿量>60ml组间比较，无统计学的差异（p>0.05）。钻孔引流术对血肿量≤60ml患者，改善神经功能缺损程度优于开颅手术。但对血肿量>60ml患者二者没有统计学的差异。
4并发症发生情况比较，开颅组肺部感染发生率35％，消化道出血发生率18％；钻孔组肺部感染发生率18％，消化道出血发生率9％，两组病人并发症发生率有统计学的差异（p<0.05）。
5不同手术方法病死率的比较：开颅组病死率20％，钻孔组病死率20％，两组病人病死率无统计学的差异（p>0.05）。
6开颅组与钻孔组术后再出血率比较：开颅组术后再出血率5％，钻孔组术后再出血率18％，两组病人再出血发生率有统计学的差异（p<0.05）。
7两组平均手术时间、血肿消失时间比较。开颅组平均手术时间为149.7±10.9min，首次血肿清除量约76.1±8.2(％)；钻孔组平均手术时间为36.2±11.3min，首次血肿清除量约39.9±7.6(％)，有统计学的差异（p<0.05）。
结论：
1开颅手术和钻孔引流术对治疗高血压脑出血有效，术后神经功能缺损程度较术前减轻。
2病情分级与疗效紧密相关，术前神经功能缺损程度越重，预后越差。术前神经功能缺损程度为中型组患者预后好于术前重型组，而术前轻型组预后又好于术前中型组。对于术前轻型组和中型组患者，钻孔引流术对于改善神经功能缺损程度优于开颅手术，但对于重型患者二者没有统计学差异。
3出血量越大临床神经功能缺损程度越重，手术后患者预后也越差。对于幕上血肿量≤60ml患者，钻孔引流术改善神经功能缺损程度优于开颅手术。但对于幕上血肿量>60ml患者二者没有统计学差异。
4开颅手术首次血肿清除量明显多于钻孔引流术，开颅术手术时间长，平均手术时间明显高于钻孔术。开颅手术并发症发生率高于钻孔术。钻孔术再出血发生率高于开颅术。开颅术与钻孔术的患者病死率没有统计学差异。
Purpose: To compare the advantages and disadvantages and curative effectof drilling drainage operation and craniotomy in the treatment of HICH,provide the basis evidence for the clinical choice of appropriate surgicalapproach.
Methods: Retrospective analysis85cases of HICH patient informationfrom2010to2012in our hospital, bone flap craniotomy group are40cases,skull drilling drainage group45cases. Preoperation, we compared the generalcharacteristics(sex, age), the degree of neurological deficits, the amount ofbleeding, the bleeding site, and the opportunity of surgery about the twogroups. According the evaluation standard in the fourth academic conferenceon cerebral vascular disease, evaluate patients’ situation of neurologicalimpairment and the severity of the disease. There is a total of45scores. Theheavier impairment is, the higher scores are. Light degree is0-15scores.Middle degree is16-30scores.Serious degree is31-45scores. The factors ofneurological impairment, complication incidence, fatality rate, rebleedingrate，operation time between the two groups after treatment for one monthwere compared.
Results：
1There were no statistical differences between the two groups in thefollowing factors，including age,general characteristics，the bleeding site, theamount of bleeding, degree of neurological deficits before treatment and thetiming of surgery.
2One month after operation, the scores of neurological impairment degree inboth groups are lower than preoperation. p<0.05, There was statisticaldifference. Comparision the neurological impairment between craniotomy anddrilling drainage after operation, p<0.05in light degree group and middle degree group,.There was statistical difference. And the neurologicalimpairment between craniotomy and drilling drainage after operation, p>0.05.There was no statistical difference. Drilling drainage operation is moreeffective for improving the degree of neurological deficits for light degreepatients and middle degree patients. But there was no statistical difference inthe treatment of severe degree patients.
3The scores of neurological impairment degree after surgery in both groupsare lower than preoperation in different amount of bleeding. p<0.05, Therewas statistical difference. After operation, the degree of neurologicalimpairment between craniotomy and drilling drainage has statistical difference,both in hematoma volume less than40ml group and between40to60ml group.p<0.05. But in hematoma volume more than60ml group, p>0.05, There wasno statistical difference. Drilling drainage operation is more effective forimproving the degree of neurological deficits for the patients whose hematomavolume was less than60ml. There was no statistical difference in treatmentfor the patients whose hematoma volume was more than60ml.
4There was statistical difference between the two groups in the incidence ofpulmonary infection and gastrointestinal bleeding during hospital.For thepulmonary infection, drilling drainage operation group is18%，craniotomygroup is35%. And for the gastrointestinal,drilling drainage operation group is9%，craniotomy group is18%.
5There was no statistical difference between the two groups in the fatality rateduring hospital，Drilling drainage operation group is20%，craniotomy groupis20%.
6There was statistical difference between the two groups in the rebleedingrate during hospital. Drilling drainage operation group is18%，craniotomygroup is5%.
7The average operation time of drilling drainage operation group is36.2±11.3min，and for craniotomy group,it’s149.7±10.9min. There was statisticaldifference between two groups. The first volume of hematoma in drillingdrainage operation group is39.9±7.6(％)，which in craniotomy group is 76.1±8.2(％).There was statistical difference between two groups.
Conclutions:
1Craniotomy and drilling drainage are effective in treating HICH. The degreeof neurologic impairment after surgery is lower than preoperation.
2Disease classification is closely related to efficacy. Clinical neurologicaldeficit is more severe, the prognosis is worse. The patients who are in middledegree group preoperative have a better prognosis than serious degree group.And light degree group are better than middle group. For the patients who isbelong to light degree group or middle group, drilling drainage is moreeffective for improving the degree of neurological deficits. But there was nostatistical difference in treatment of severe patients.
3The amount of bleeding is more great, the clinical neurological deficit ismore severe. The prognosis of patients after surgery is worse. The patientswhose hematoma volume was less than60ml, drilling drainage is moreeffective for improving the degree of neurological deficits. There was nostatistical difference in treatment for the patients whose hematoma volumewas more than60ml.
4Craniotomy can remove more hematoma than drilling drainage operation forthe first time. The average time of craniotomy was longer than drillingdrainage operation. The complication rate of Craniotomy is higher than thedrilling drainage operation. The rebleeding rate of Craniotomy was higherthan drilling technique. There was no statistical difference in fatality rate.
引文
1杨期东，周艳宏，王文志等．中国3个城市社区人群脑卒中死亡及其类型分稚特征．中华老年心血管病杂志，2003，5(1)：39-43
2Zhang LF, Yang J Hong Z. ct a1. Proportion of different subtypes of strokein China. Stroke,2003,34(12)：2091-2096
3李良寿(王桂清主编)．卒中的流行病学，卒中的监测与防治．上海：上海科技教育出版社，2003.1-53
4Siddique MS, Fernandes HM, Wooldridge TD, et a1. Reversible ischemiaaround intracerebral hemorrhage: asingle-photon emission computerizedtomography study. J Neurosurgery,2001,96(4):736-741
5刘力生，龚兰生．中国高血压防治指南．高血压杂志．2000，8(1)：94-102徐兆辉.高血压脑溢血的微创外科治疗[J].中外医疗,2010,29(24):48
6中华神经外科学会，中华神经内科学会．脑卒中患者临床神经功能缺损程度评分标准(1995)[J]．中华神经科杂志，1996；29(6)：381-383
7刘力生，龚兰生．中国高血压防治指南．高血压杂志．2000，8(1)：94-102何庆华.高血压脑溢血手术治疗分析[J].现代中西医结合杂志,2007,16(24):35-32
8Murthy JM, Chowdary GV, Murthy TV, et al. Decompressive craniectomywith clot evacuation in large hemispheric hypertensive intracerebralhemorrhage. Neuroerit Care,2005,2:258
9庞力，周良辅．微创手术治疗高血压脑出血的术式比较．中国微侵袭神经外科杂志，2001,6(3):147-150
10勾俊龙，毛群等．立体定向治疗高向压脑出血60例临床分析．中华神经外科杂志，2003,19:149-150
11王彬,孙峰,王文华,等.标准外伤大骨瓣减压术治疗重型颅脑损伤的临床效果[J].浙江中医药大学学报,2008,32(3):345-346
12杜建新，凌锋，谌燕飞，等．小骨窗丌颅术和钻孔引流术治疗脑出血疗效的对比研究．中国脑血管病杂志，2004，l(7)：292-294
13朱永祥，曹树平．侧脑室穿刺持续外引流治疗脑室出血(附ll例报告)．临床神经病学杂志，1997.10(6)：354
14Robert G．Grossman。Christopher M．Loftus主编，王任直主译．神经外科学．北京：人民卫生出版社，2002：261
15汤崇辉,刘伟国.高血压脑出血手术治疗的临床研究[J].心脑血管防治,2008,8(6):377-379
16卢国奇,蔡娟丽,马国峡,等.高血压脑出血外科治疗96例[J].第四军医大学学报,2007,28(17):1596
17王建清，陈衔城，吴劲松等，高血压脑出血手术时机的规范研究，中国微侵袭神经外科杂志，2003,8(1):3-4
18廖月生，治疗高血压脑出血手术时机选择及疗效比较[J],赣南医学院学报,2010,30(1):92-93
1王文志．脑血管病的流行病学．见：栗秀初，范学文主编．现代脑血管病学．第l版．je京：人民军医出版社，2003.110-118
2Brodefick JP, Adams HP Jr, Barsan W: et a1. Guidelines for themanagement of spontaneous intracerebral hemorrhage: A statement forhealthcare professionals from a special writing group of the Stroke Council,American Heart Association. Strokc,1999,30:905-915
3赵雅度．高血压脑出血的外科治疗．全国神经内科主任(微创血肿清除术)高研班讲义.北京.2005.38-45
40bservation F, Mil1erC. Hypertensive Cerebral Hemorrhage. Demonstra-tion of the Source of B1eeding[J]. Neuropath0109y ExperimentalNeur0109y,2003,62(1):104-107
5Fewel M E, Thompson B G, Hoff J T. Spontaneous intracerebralhemorrhage: a review[J]. Neurosurg Focus,2003,15(3):81-85
6Qureshi A I, Tuhrim S, Brodederick J peta1. Spontaneous intracerebralhemorrhage[J]. N Eng J Med,2001,344:1450-1460
7刘华兴.高血压脑溢血手术预后影响因素分析[J].中国现代医药杂志,2009,11(12):54-55
8Qureshi AI, Tuhrim S, Broderick JP, Batjer HH, Hondo H, Hanley DF.Spontaneous intracerebral hemorrhage. N Engl J Med.2001;344:1450-1460
9Diringer MN. Intracerebral hemorrhage: Pathophysiology and manage-ment. Crit Care Med.1993;21:1591-1603
10Xu Y, Wanga Y, Feng L, et al. Treatment and outcome of intracranialhemorrhage after carotid artery stenting. A ten year single centerexperience [J]. Interv Neuroradiol,2009,15(3):316-324
11赵雅度．高血压脑出血的外科治疗．全国神经内科主任(微创血肿清除术)高研班讲义.北京.2005.38-45
12Kanno T, Nagata J, Nonomura K, et a1. New approaches in the treatment,ofhypertensiveintracerebralhemorrhage. Stroke,1993,24(1):96
13Kaneko M, Tanaka l('Shimada T'et a1. Long-term evaluation of ultra-earlyoperation for Hypertensive intraccrebral hemorrhage in100cases. JNeurosurg,1983,58(8):838·842
14Kazui S, Naritomi H, Yamamoto H, et a1. Enlargenment of spontaneousintracerebral hemorrhage Incidence and time Course. Stroke,1996,27(10):1783-1787
15王建清，陈衔城，吴劲松等．高血压脑出血手术时机的规范研究．中国微侵袭神经外科杂志.2003,8(1):3-4
16Morgenstem LB, Demchuk AM, Kim DH, et al. Rebleeding leads topool outcome in ultra-early craniotomy for intracerebral hemorrhage.Neurology,200156(10)1294-1299
17陶英群,薛洪利,王涵伟等.额颞部大骨瓣开颅侧裂入路治疗合。并脑疝的高血压脑基底节出血临床分析[J].中国临床神经外科杂志,2009,
14(1):10-12
18李云辉，林中平，黄建龙，等．超早期锁孔血肿清除术治疗高血压基底节出血24例．中国危重病急救医学2005;17:31-36
19万宏，张建平，范忠秀，等．高血压性脑出血微创治疗．中国临床神经科学，1999;7:18-39
20李树春，赵振华．微创手术治疗高血压脑出血临床分析．中国现代神经疾病杂志.2005;5:171
21庞力，周良辅．微创手术治疗高血压脑出血的术式比较．中国微侵袭神经外科杂志,2002,6(3):147-150
22罗自勉,宋治,付林,等.双侧脑室引流联合脑脊液置换治疗重型脑室出血的临床研究[J].临床急诊杂志,2007,8(6):334-336
23Chiu D, Peterson L, Elkind MS, et al. Comparison of outcomes afterintracerebral hemorrhage and ischemic stroke.[J]. J Stroke Cerebrovasc Dis,2010,19(3):225-229
24周永胜,黄冠敏,张业斌,等,常规开颅手术及立体定向微创治疗高血压脑出血52例疗效分析[J],立体定向和功能性神经外科杂志，2009,22(2):98-100
25牟朝晖,吴剑,杨明,等,神经内镜辅助手术治疗高血压脑出血[J],中华神经医学杂志,2007,6(5):503-504
26陈祎招,徐如祥,赛力克,等,高血压脑出血神经内镜微创手术与开颅血肿清除术的临床比较分析[J],中国神经精神疾病杂志,2010,36(10):616-619
27杨新建名申经内窥镜的临床应用，中国内镜杂志.1997,3(3):18
2Zhang LF, Yang J Hong Z. ct a1. Proportion of different subtypes of strokein China. Stroke,2003,34(12)：2091-2096
3李良寿(王桂清主编)．卒中的流行病学，卒中的监测与防治．上海：上海科技教育出版社，2003.1-53
4Siddique MS, Fernandes HM, Wooldridge TD, et a1. Reversible ischemiaaround intracerebral hemorrhage: asingle-photon emission computerizedtomography study. J Neurosurgery,2001,96(4):736-741
5刘力生，龚兰生．中国高血压防治指南．高血压杂志．2000，8(1)：94-102徐兆辉.高血压脑溢血的微创外科治疗[J].中外医疗,2010,29(24):48
6中华神经外科学会，中华神经内科学会．脑卒中患者临床神经功能缺损程度评分标准(1995)[J]．中华神经科杂志，1996；29(6)：381-383
7刘力生，龚兰生．中国高血压防治指南．高血压杂志．2000，8(1)：94-102何庆华.高血压脑溢血手术治疗分析[J].现代中西医结合杂志,2007,16(24):35-32
8Murthy JM, Chowdary GV, Murthy TV, et al. Decompressive craniectomywith clot evacuation in large hemispheric hypertensive intracerebralhemorrhage. Neuroerit Care,2005,2:258
9庞力，周良辅．微创手术治疗高血压脑出血的术式比较．中国微侵袭神经外科杂志，2001,6(3):147-150
10勾俊龙，毛群等．立体定向治疗高向压脑出血60例临床分析．中华神经外科杂志，2003,19:149-150
11王彬,孙峰,王文华,等.标准外伤大骨瓣减压术治疗重型颅脑损伤的临床效果[J].浙江中医药大学学报,2008,32(3):345-346
12杜建新，凌锋，谌燕飞，等．小骨窗丌颅术和钻孔引流术治疗脑出血疗效的对比研究．中国脑血管病杂志，2004，l(7)：292-294
13朱永祥，曹树平．侧脑室穿刺持续外引流治疗脑室出血(附ll例报告)．临床神经病学杂志，1997.10(6)：354
14Robert G．Grossman。Christopher M．Loftus主编，王任直主译．神经外科学．北京：人民卫生出版社，2002：261
15汤崇辉,刘伟国.高血压脑出血手术治疗的临床研究[J].心脑血管防治,2008,8(6):377-379
16卢国奇,蔡娟丽,马国峡,等.高血压脑出血外科治疗96例[J].第四军医大学学报,2007,28(17):1596
17王建清，陈衔城，吴劲松等，高血压脑出血手术时机的规范研究，中国微侵袭神经外科杂志，2003,8(1):3-4
18廖月生，治疗高血压脑出血手术时机选择及疗效比较[J],赣南医学院学报,2010,30(1):92-93
1王文志．脑血管病的流行病学．见：栗秀初，范学文主编．现代脑血管病学．第l版．je京：人民军医出版社，2003.110-118
2Brodefick JP, Adams HP Jr, Barsan W: et a1. Guidelines for themanagement of spontaneous intracerebral hemorrhage: A statement forhealthcare professionals from a special writing group of the Stroke Council,American Heart Association. Strokc,1999,30:905-915
3赵雅度．高血压脑出血的外科治疗．全国神经内科主任(微创血肿清除术)高研班讲义.北京.2005.38-45
40bservation F, Mil1erC. Hypertensive Cerebral Hemorrhage. Demonstra-tion of the Source of B1eeding[J]. Neuropath0109y ExperimentalNeur0109y,2003,62(1):104-107
5Fewel M E, Thompson B G, Hoff J T. Spontaneous intracerebralhemorrhage: a review[J]. Neurosurg Focus,2003,15(3):81-85
6Qureshi A I, Tuhrim S, Brodederick J peta1. Spontaneous intracerebralhemorrhage[J]. N Eng J Med,2001,344:1450-1460
7刘华兴.高血压脑溢血手术预后影响因素分析[J].中国现代医药杂志,2009,11(12):54-55
8Qureshi AI, Tuhrim S, Broderick JP, Batjer HH, Hondo H, Hanley DF.Spontaneous intracerebral hemorrhage. N Engl J Med.2001;344:1450-1460
9Diringer MN. Intracerebral hemorrhage: Pathophysiology and manage-ment. Crit Care Med.1993;21:1591-1603
10Xu Y, Wanga Y, Feng L, et al. Treatment and outcome of intracranialhemorrhage after carotid artery stenting. A ten year single centerexperience [J]. Interv Neuroradiol,2009,15(3):316-324
11赵雅度．高血压脑出血的外科治疗．全国神经内科主任(微创血肿清除术)高研班讲义.北京.2005.38-45
12Kanno T, Nagata J, Nonomura K, et a1. New approaches in the treatment,ofhypertensiveintracerebralhemorrhage. Stroke,1993,24(1):96
13Kaneko M, Tanaka l('Shimada T'et a1. Long-term evaluation of ultra-earlyoperation for Hypertensive intraccrebral hemorrhage in100cases. JNeurosurg,1983,58(8):838·842
14Kazui S, Naritomi H, Yamamoto H, et a1. Enlargenment of spontaneousintracerebral hemorrhage Incidence and time Course. Stroke,1996,27(10):1783-1787
15王建清，陈衔城，吴劲松等．高血压脑出血手术时机的规范研究．中国微侵袭神经外科杂志.2003,8(1):3-4
16Morgenstem LB, Demchuk AM, Kim DH, et al. Rebleeding leads topool outcome in ultra-early craniotomy for intracerebral hemorrhage.Neurology,200156(10)1294-1299
17陶英群,薛洪利,王涵伟等.额颞部大骨瓣开颅侧裂入路治疗合。并脑疝的高血压脑基底节出血临床分析[J].中国临床神经外科杂志,2009,
14(1):10-12
18李云辉，林中平，黄建龙，等．超早期锁孔血肿清除术治疗高血压基底节出血24例．中国危重病急救医学2005;17:31-36
19万宏，张建平，范忠秀，等．高血压性脑出血微创治疗．中国临床神经科学，1999;7:18-39
20李树春，赵振华．微创手术治疗高血压脑出血临床分析．中国现代神经疾病杂志.2005;5:171
21庞力，周良辅．微创手术治疗高血压脑出血的术式比较．中国微侵袭神经外科杂志,2002,6(3):147-150
22罗自勉,宋治,付林,等.双侧脑室引流联合脑脊液置换治疗重型脑室出血的临床研究[J].临床急诊杂志,2007,8(6):334-336
23Chiu D, Peterson L, Elkind MS, et al. Comparison of outcomes afterintracerebral hemorrhage and ischemic stroke.[J]. J Stroke Cerebrovasc Dis,2010,19(3):225-229
24周永胜,黄冠敏,张业斌,等,常规开颅手术及立体定向微创治疗高血压脑出血52例疗效分析[J],立体定向和功能性神经外科杂志，2009,22(2):98-100
25牟朝晖,吴剑,杨明,等,神经内镜辅助手术治疗高血压脑出血[J],中华神经医学杂志,2007,6(5):503-504
26陈祎招,徐如祥,赛力克,等,高血压脑出血神经内镜微创手术与开颅血肿清除术的临床比较分析[J],中国神经精神疾病杂志,2010,36(10):616-619
27杨新建名申经内窥镜的临床应用，中国内镜杂志.1997,3(3):18