目的：探讨经膜髓帆入路手术治疗桥脑高血压相关性脑出血的适应证和围手术期处理及预后。方法回顾性分析23例桥脑背侧高血压相关性脑出血患者的临床资料，均经膜髓帆入路行手术治疗。结果23例患者以头颅CT显示脑干出血最大层面面积占该层脑干面积的百分比分组，小血肿组（≤50％）5例，大血肿组（＞50％）18例，均行手术治疗。死亡7例，病死率30．4％（7／23例）。结论对于桥脑背侧高血压相关性出血患者，血肿量＞50％或虽≤50％但意识障碍及神经系统症状进行性恶化或伴有急性梗阻性脑积水者应积极手术，膜髓帆入路是该部位出血手术治疗的理想入路，围手术期的有效处理可以提升疗效。%Objective To study the surgical treatment strategies , advantages and surgical indications of hypertensive pontine hemorrhage through transtelovelar approach .Methods A retrospective analysis of clinical data in 23 cases with hypertensive pontine hemorrhage from January 2010 to December 2014 in Lianyungang First People's Hospital.Results In the all 23 patients, hemorrhage located in the back of pons .According to percentage of the maximum level of pontine hemorrhage area and the pontine area ,there were 5 patients in small hematoma group (≤50%) ,and 18 cases in large hematoma group (>50%) ,All patients received microsurgical treatment to remove the hematoma through transtelovelar approach .The mortality was 30.4%(7/23).Conclusions The transtelovelar approach can provide adequately exposure to remove the pontine hematoma .The efficacy and prognosis of surgical treatment were satisfactory .Follow the surgical indication for pontine hemorrhage ,it can effectively reduce the mortality of pontine hemorrhage .
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