目的：探讨简易颅表定位CT引导下微创手术治疗高血压性脑出血的临床效果。方法回顾性分析352例基底核区高血压性脑出血病例的临床资料,其中采用简易颅表定位CT引导下微创手术治疗138例(定位组),传统骨瓣开颅血肿清除术治疗87例(骨瓣组),小骨窗开颅血肿清除术治疗127例(骨窗组),比较3种不同手术方法的疗效。结果3组术后血肿残留量和血肿清除率差异均有统计学意义(P＜0.05),定位组血肿残留量最少、血肿清除率最高；与骨窗组、骨瓣组比较,定位组病死率最低,差异有统计学意义(P＜0.05)；而3组再出血率差异无统计学意义(P＞0.05)。术后6个月ADL分级比较,3组差异有统计学意义(P＜0.05),定位组预后最好。结论简易颅表定位CT引导下微创手术治疗中等量脑深部出血疗效确切,操作简单,适合在基层医院推广。%Objective To investigate the clinical efficacy of the minimally invasive surgery guided by CT-based homemade cranial locator (CTL) for hypertensive cerebral hemorrhage (HCH). Methods Clinical data of 352 patients with HCH in the basal ganglia region were analyzed retrospectively. Minimally invasive surgery guided by CTL was performed in 138 patients (location group), hematoma evacuation by traditional bone flap craniotomy in 87 patients (bone flap group) and hematoma evacuation by a small bone window craniotomy in 127 patients (bone window group). The surgical outcomes of the three methods were compared. Results There was a statistical significance in hematoma residual quantity and hematoma evacuation rate between the three groups (P< 0.05). The least hematoma residual quantity, the highest hematoma evacuation rate and the lowest mortality rate were found in the location group. However, there was no significant statistical difference in rebleeding rate between the three groups (P>0.05). Significant difference was found in the ADL grade at 6 months after surgery between three groups (P<0.05), and the prognosis was best in the location group. Conclusion The minimally invasive surgery guided by CTL is an effective and simple operation for moderate cerebral hemorrhage in the basal ganglia region, and fit for primary hospital.
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