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目的评价不同手术方式治疗重型脑室出血并铸型的疗效。方法采用随机对照法分析51例经开颅脑室内血肿清除术(开颅组)和75例经单纯侧脑室钻孔外引流术(钻孔组)治疗的脑室出血并铸型患者的临床资料,比较两组术后血肿完全清除时间、手术并发症、格拉斯哥预后分级(GOS)评分以及日常生活活动能力(ADL)评分的差异。结果1脑室内血肿完全清除时间:开颅组平均(5.24±0.41)d,钻孔组平均(16.85±0.37)d,组间差异有统计学意义(P<0.05);2开颅组术后颅内再出血、脑积水、颅内感染、肺部感染的发生率均明显低于钻孔引流组,组间均差异有统计学意义(P<0.05);3出院时GOS评分:开颅组恢复良好15例,轻残14例,重残10例,植物生存5例,死亡7例;钻孔组恢复良好5例,轻残7例,重残16例,植物生存19例,死亡28例。随访6~12个月,ADL评分开颅组[平均(47.84±2.45)分]明显优于钻孔组[平均(27.97±3.12)分],差异有统计学意义(P<0.05)。结论开颅脑室内血肿清除术的疗效明显优于单纯脑室钻孔外引流术,是治疗重型脑室出血并铸型的一种有效方法,可显著降低术后并发症,提高患者生存率和生存质量。
Objective To evaluate the curative effect of different surgical methods in the treatment of severe intraventricular hemorrhage and mold. Methods The clinical data of 51 patients with intraventricular hemorrhage (Craniotomy) and 75 patients with intraventricular hemorrhage (B group) treated by simple lateral ventricle drilling drainage were analyzed by randomized controlled clinical trial. The differences of postoperative hematoma complete eradication time, operative complications, Glasgow prognostic grade (GOS) score, and daily living activity (ADL) score were compared. Results The complete eradication time of ICH was 5.24 ± 0.41 days in the craniotomy group and 16.85 ± 0.37 days in the drilling group (P <0.05). There was no significant difference between the two groups The incidences of intracranial hemorrhage, hydrocephalus, intracranial infection and pulmonary infection were significantly lower than those in the group of drilling drainage (P <0.05) .3 The GOS score at discharge: There were 15 cases with good recovery, 14 cases with mild disability, 10 cases with severe disability, 5 cases with plant survival and 7 cases with death. There were 5 cases with well recovery, 16 cases with severe disability, 16 cases with severe disability, 19 cases of plant survival and 28 cases of death example. The follow-up ranged from 6 to 12 months. The mean craniotomy group (mean 47.84 ± 2.45) in the ADL group was significantly better than that in the drilling group [mean 27.97 ± 3.12], with significant difference (P <0.05). Conclusion The curative effect of intracranial hematoma removal is better than that of simple ventricular extracavitary drainage. It is an effective method to treat severe ventricular hemorrhage and mold, which can significantly reduce the postoperative complications and improve the survival rate and quality of life .