Abstract：Objective To investigate the influence of timing of surgery and surgical approach on the patients with hypertensive cerebral hemorrhage at the different sites.Methods The clinical data of 106 hypertensive cerebral hemorrhage patients with surgery in Chaohu Hospital of Anhui Medical University from March 2006 to August 2013 were retrospectively analyzed. According to the time from onset to surgery, these patients were divided into three groups: the ultra-early group(≤6 h, n=53), the early group(6-24 h, n=30), and the delayed group(>24 h, n=23). Taking different surgical methods based on the site of bleeding, then according to these surgical approaches, patients were divided into three groups: 52 cases were treated with small bone window hematoma evacuation(the small bone window group), including 35 cases of basal ganglia, 11 cases of subcortical, and 6 cases of cerebellar hemorrhage, 34 cases were treated with trauma craniotomy hematoma removing surgery(the craniectomy group), including 21 cases of basal ganglia and 13 cases of cerebellar hemisphere; 20 cases were treated with lateral external drainage(the external drainage group), including 8 cases of chronic brain stem hemorrhage broken into ventricles and 12 cases of thalamic hemorrhage rupturing into ventricle. The Glassgow outcome scale (GOS) was compared after one month and the activities of daily living (ADL) classification was evaluated after six months for the patients with the three different surgical approaches and three different timing of surgery.Results The results of the surgery after one month showed the recent excellent rate(81.13%, 43/53)in the ultra-early group was higher than the early group (50.00%, 15/50)and delayed group (43.48%, 10/23), the difference were statistically significant (all P values<0.01), while the difference between the early group and the delayed group was no statistically significant (P>0.05). One month after operation, there is one case of death in each group. The results of the surgery after six month showed that the long-dated excellent rate(94.23%, 49/52)in the ultra-early group was higher than early group (51.72%, 15/29)and delayed group (50.00%, 11/22), the difference was statistically significant (all P values<0.01), while the difference between the early group and the delayed group was no statistically significant (P>0.05).The difference of the recent excellent rate in the GOS score (71.15%, 37/52), 52.94%(18/34), 65.00%(13/20) and the long-dated excellent rate in the ADL Ⅰ-Ⅲ grade level(76.47%(39/51), 68.75%(22/32), 75.00%(15/20) between the small bone window group, the craniotomy group and the external drainage group were no statistically significant (all P values>0.05).Conclusions Patients with hypertensive cerebral hemorrhage in different parts should be selected different surgical methods and appropriate timing of surgery for individualized treatment, then obtain the corresponding efficacy.
李克和,黄录茂,雍成明,杨代明,宣家龙,徐兵. 手术方式与时机的选择对不同部位高血压脑出血患者预后的影响[J]. 中华解剖与临床杂志, 2015, 20(3): 230-235.
Li Kehe, Huang Lumao, Yong Chengming, Yang Daiming, Xuan Jialong, Xu Bing. The clinical research on the timing of surgery and surgical approach for the patients with different parts of the hypertensive cerebral hemorrhage. Chinese Journal of Anatomy and Clinics, 2015, 20(3): 230-235.
2015, Vol. 20 
