摘要：

高血压脑出血发病率、病死率和病残率均较高，相较药物保守治疗，外科手术治疗的有效性尚存争议，但外科手术是改善高血压脑出血患者预后最有前景的方法。目前手术方式主要有 3 种，开颅血肿清除术可以直视下清除血肿，止血可靠，但手术切口较大、手术时间较长、术中出血较多，神经功能恢复常不够理想；血肿穿刺置管引流术手术切口较小，对正常脑组织影响较小，但血肿清除不彻底，可能增加颅内感染风险；神经内镜下血肿清除术手术切口较小，可以有效减少神经纤维束损害，血肿清除彻底。上述 3 种手术方式的疗效尚缺乏前瞻性临床研究证实，期待微创手术和开颅手术治疗幕上高血压脑出血比较（MISICH）研究可以提供高质量的研究数据和高级别的循证医学证据。

关键词: 颅内出血, 高血压性, 神经外科手术, 综述

Abstract:

Hypertensive intracerebral hemorrhage (ICH) is a disease with high morbidity, disability rate and mortality. Compared with conservative treatment, the effectiveness of surgery is still controversial. However, surgery is the most promising treatment to improve prognosis of hypertensive ICH. There are currently three main surgical methods. Craniotomy removes the hematoma under microscope and can achieve reliable hemostasis. Limited by large trauma, relatively long operation time and massive bleeding in operation, the neurological function recovery of patients treated by this procedure is not ideal. Hematoma puncture and catheter drainage brings least injury to normal brain tissue. Nevertheless, the neurosurgeon is unaware of the intracranial situation when operating, and urokinase injection may increase the risk of intracranial infection. Endoscopic hematoma evacuation can completely remove the hematoma, which is less invasive and may avoid damage to nerve fiber bundle. Prospective studies investigating the efficacies of these three surgical approaches are lacking, while the Minimally-Invasive Surgery versus Craniotomy in Patients with Supratentorial Hypertensive Intracerebral Hemorrhage (MISICH) study is expected to provide better data and evidence.

Key words: Intracranial hemorrhage, hypertensive, Neurosurgical procedures, Review