高血圧性脳出血の外科的治療 : 自験例174症例の検討

概要

論文の詳細を見る
Clinical investigations on surgical treatment of hypertensive intracerebral hemorrhage have been carried out in the Department of Neurosurgery at Iwate Medical University for the last 14 years. Operative cases numbered 174, excluding cases of secondary pontine nor cerebellar hemorrhage, and the data presented concern operalive mortality and morbidity. As to the operative mortality within one month after surgery, death occurred in 59(33.9%) out of 174 patients. However, patients who had been operated on during the last 5 years, death occurred in 23 out of 99. In the latter series, of 28 patients who had been alert or somnolence with minor neurological deficits (Grade I in our neurological classification),none died, but 14 (25.5%) of 55 Grade II patients who had been stuporous with moderate neurological deficits died. Of 45 Grade III patients who had been semicomatose with normal or abnormal size of the pupils, hemiplegic and with mild vegetative disturbances 15 (33.3%) died. Of 32 Grade IV patients who had been semicomatose with abnormal size of the pupils, tetraplegic or hemiplegic with decerebrate or decorticate rigidity and with severe vegetative disturbances 17 (53.1%) died. Of 14 Grade V patients who had been comatose with abnormal size of the pupils, tetraplegic or hemiplegic with decerebrate regidity and with severe vegetative disturbances 13 (92.9%) died. The operative mortality under 39 years of age was 16%, while it was approximately 40% in each decade above 40 years. Of the total cases, 126 patients had the lateral type of hematoma which was located outside the internal capsule and 31 patients had the combined type of hematoma which was located in the internal capsule and the thalamus. The former showed 24.6% operative mortality, while the latter showed 71%. Total evacuation of the hematoma was performed in 147 patients and the operative mortality was 29.3%. The result was better than in cases of partial evacuation (63.2%) and of internal or external decompression only (50%). Operative mortalities according to the timing of the operation after the attack of hemorrhage varied as follows: One day-25%, 2-3days-24%, and 4-9days-9.1%. Follow-up study from four months to 13 years after surgery was carried out with 98 patients, and the results showed that 32 (32.9%) were well (able to work fully with minimal disability), 21(21.4%) were partially disabled, and II (ll.2%) were totally disabled. Death occured in 34 out of the 98 patients and the mortality was 34.4% during follow-up period.
日本脳神経外科学会の論文

高血圧性脳出血の外科的治療 : 自験例174症例の検討

スポンサーリンク

概要

著者

関連論文

スポンサーリンク