总结高血压基底节区脑出血骨窗开颅术后血肿复发手术治疗经验。

回顾分析河北省迁西县人民医院自2013年2月至2019年2月高血压基底节区脑出血行急诊骨窗开颅血肿清除减压术患者413例（一般发病4 h内）的临床资料。所有患者术中均仔细止血，术后入住重症监护病房，积极监控血压，维持血压在150/100 mmHg（1 mmHg=0.133 kPa）以下，术后复查显示原血肿腔血肿复发22例，血肿量30~50 ml。血肿复发患者分别行再次开颅血肿清除术和经皮定位微创穿刺血肿引流术治疗。评价患者手术效果并做术后随访。术后1个月所有血肿复发患者进行格拉斯哥昏迷量表（GCS）评分，术后半年评价患者日常生活能力分级情况。

微创穿刺患者术区脑组织密度情况明显较再次开颅者相应图像密度更接近正常。术后1个月时GCS评分情况：再次行开颅血肿清除术的6例患者中GCS评分为7分者1例，8分者1例，9分及以上4例；再次行血肿经额部定位穿刺术的16例患者中GCS评分为7分者1例，8分者2例，9分及以上者13例。随访半年后，再次行开颅血肿清除术的6例患者中，日常生活能力分级Ⅰ~Ⅱ级4例，Ⅲ级1例，Ⅳ~Ⅴ级1例；行血肿经额部定位穿刺术的16例患者中，日常生活能力分级Ⅰ~Ⅱ级12例，Ⅲ级2例，Ⅳ~Ⅴ级2例。

经额定位血肿微创穿刺引流治疗技术是高血压基底节区脑出血骨窗开颅术后原术腔血肿复发治疗的有益补充。

To summarize the experience of surgical treatment of recurrent hematoma after craniotomy for hypertensive basal ganglia cerebral hemorrhage.

From February 2013 to February 2019, 413 cases of hypertensive basal ganglia cerebral hemorrhage in Qianxi People's Hospital received emergency craniotomy for hematoma removal and decompression, and 22 cases of postoperative hematoma recurrence were retrospectively analyzed. All cases were received carefully intraoperative hemostasis, postoperative ICU admission, active monitoring of blood pressure, and maintaining of blood pressure below 150/100 mmHg. 22 cases displayed postoperative hematoma recurrence in the original hematoma cavity, about 30 to 50 ml. Patients with recurrence of hematoma were treated with craniotomy and percutaneous minimally invasive drainage. To evaluate the effect of operation, Glasgow coma scale (GCS) score was used for all patients with hematoma recurrence one month after operation, and the daily life ability grade was evaluated half a year after operation.

The prognosis of patients with recurrent hematoma after craniotomy by minimally invasive puncture was better than that of patients with recurrent hematoma after craniotomy for hypertensive basal ganglia hemorrhage. One month after the operation, there was one case with GCS score of 7 in 6 patients with craniotomy, one case with GCS score of 8, and four cases with GCS score of 9 and above; there was one case with GCS score of 7 was found in 16 patients with recurrent hematoma via frontal puncture, two cases with GCS score of 8, and 13 cases with GCS score of 9 and above. After six months of follow-up, of the 6 patients who underwent craniotomy again, there were four cases with Grade Ⅰ~Ⅱ, one case with Grade III, and one case with Grade Ⅳ~Ⅴ; Of the 16 patients with hematoma undergoing frontal localization, there were 12 cases with Grade Ⅰ~Ⅱ, two cases with Grade III, and one case with Grade Ⅳ~Ⅴ.

Minimally invasive puncture and drainage of hematoma through frontal localization is a beneficial supplement to the treatment of recurrence of hematoma in the original operation cavity after craniotomy for hypertensive basal ganglia intracerebral hemorrhage.