Schwarz S, Jauss M, Krieger D, Dörfler A, Albert F, Hacke W
Department of Neurology, University of Heidelberg, Federal Republic of Germany.
Acta Neurochir (Wien). 1997;139(10):897-903; discussion 903-4. doi: 10.1007/BF01411297.
Surgical intervention in supratentorial intracerebral haemorrhage (ICH) is still controversial. We assessed the value of haematoma evacuation with a case-control study. 145 consecutive patients with supratentorial spontaneous ICH without tumour or vascular abnormalities were analysed. Haematoma evacuation was performed in 24 patients. Age, sex, Glasgow Coma Scale (GCS), level of consciousness, pupillary reaction on admission, localisation, aetiology and volume of the haematoma, presence of ventricular blood, and Glasgow Outcome Scale (GOS) on discharge were analysed. From statistical analysis 40 patients > 80 years and with haematoma volume < 10 ml, who were always treated conservatively, were excluded. Prognostic factors retained from a multiple regression model with the dichotomised GOS scale (GOS 1-3, 4 + 5) as response variable were GCS, haematoma volume and location. The only difference between all medically treated and "operated" patients was haematoma volume, which was larger in the "operated" patients. All 24 evacuated cases could be matched to a medically treated control regarding age, haematoma volume and location, GCS, and pupillary reaction. Significant differences between the two groups could not be detected. Outcome was not different between the two groups. After separating the sample into patients with and without ventricular haemorrhage, there was no different outcome between the two groups either. We conclude that haematoma evacuation did not improve outcome in supratentorial spontaneous ICH. Since haematomas were evacuated mainly in clinically deteriorating patients, our data suggest that the only effect of haematoma evacuation is to stop progressive deterioration rather than to improve overall clinical outcome.
幕上脑出血（ICH）的外科干预仍存在争议。我们通过病例对照研究评估了血肿清除术的价值。分析了145例连续的幕上自发性ICH患者，这些患者无肿瘤或血管异常。24例患者接受了血肿清除术。分析了患者的年龄、性别、格拉斯哥昏迷量表（GCS）、意识水平、入院时瞳孔反应、血肿的位置、病因和体积、脑室积血情况以及出院时的格拉斯哥预后量表（GOS）。经统计分析，排除了40例年龄>80岁且血肿体积<10 ml的患者，这些患者均接受保守治疗。以二分法的GOS量表（GOS 1 - 3，4 + 5）作为反应变量，从多元回归模型中保留的预后因素为GCS、血肿体积和位置。所有接受药物治疗和“手术”治疗的患者之间唯一的差异是血肿体积，“手术”治疗的患者血肿体积更大。所有24例接受血肿清除的病例在年龄、血肿体积和位置、GCS以及瞳孔反应方面都能与接受药物治疗的对照病例匹配。两组之间未检测到显著差异。两组的预后无差异。将样本分为有脑室出血和无脑室出血的患者后，两组的预后也没有差异。我们得出结论，幕上自发性ICH的血肿清除术并不能改善预后。由于血肿清除主要针对临床病情恶化的患者，我们的数据表明，血肿清除的唯一作用是阻止病情进行性恶化，而不是改善总体临床结局。
