超早期手術の再評価について
―高血圧性外側型脳出血166例の検討―
1980 年 20 巻 9 号 p. 907-913
詳細
1980 年 20 巻 9 号 p. 907-913
In 1967 we proposed, in cases of hypertensive intracerebral hemorrhage, that operative treatment be carried out in the per-acute stage or surgery within 7 hours after ictus, and stressed the importance of the time factor. Now, after sufficient time has elapsed for observation, we would like to reevaluate the result of surgery in the peracute stage as compared to other operative series in the later stage and to non-operative series.
During the past 7 years, 300 cases of hypertensive intracerebral hemorrhage, including 166 cases of the lateral type or putaminal hemorrhage, have been admitted. Operation in the per-acute stage was carried out in 84 cases presenting definite surgical indications. Delayed operations were performed in 36 cases. Operation was not indicated for the remaining 46 cases as some were too severe and the others too mild. A comparison was made of several items, such as neurological grading on admission and condition at discharge using ADL classification of functional recovery.
As a result, the per-acute operation series was observed to have much better functional recovery as compared to the other series: 82% of all per-acute operation cases were discharged with ADL grade 3 or better, or they could at least walk with a cane. In the lateral type of hypertensive intracerebral hemorrhage series, 66% of the cases were discharged with ADL grade 3 or better. A more marked difference in the outcome was noted in the group of severe cases in which there was a state of semicoma or worse at admission: more than 60% in the per-acute operation series were discharged with ADL grade 3 or better, whereas only 30% in the delayed operation group could be discharged with ADL grade 3 or better.
Eight patients in the per-acute operation series died: two with myocardial infarction, two with reaccumulation of hematoma, one of G. I. bleeding, and three of fulminant progression immediately before surgery.
To conclude, this study reconfirmed that operation in the per-acute stage is advantageous in cases of the lateral type of hypertensive intracerebral hemorrhage.
