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Neurological Surgery 脳神経外科38巻10号

2010年10月発行

文献概要

研究

Striatocapsular hemorrhageに対する開頭血腫除去術による治療成績

著者: 数又研1 横山由佳1 浅岡克行1 板本孝治1 牛越聡1 長内俊也1

所属機関: 1手稲渓仁会病院脳神経外科

ページ範囲:P.903 - P.912

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Ⅰ.はじめに

 脳神経外科医は被殻出血において浮腫,周辺組織の壊死,圧迫による二次的損傷を外科的に軽減することにより病態を改善する試みを続けてきた2-6,8-10,12,15-27,30,32-37).しかし方法,適応,有効性について議論は分かれ,概して外科的治療は有効とは言えないという文脈で語られることも多い1,7,13,14,28,29,35).その根拠とされしばしば引用される代表的な研究はrandomized controlled trial(RCT)の6報告,1990年に行われた日本脳卒中学会での大規模研究,2005年のSTICH(Surgical Trial in Intracerebral Hemorrhage)trialなどである2,3,13,15,18,23-25,33,36),しかし,対象を被殻出血に限定したものは3研究のみであり3,18,33),軽度の神経脱落症状や自立した状態を機能回復のゴールとした研究は基底核部の出血の病態生理を反映したものとは必ずしも言えない3,13,15).STICH trialでは重症例で治療転帰のゴールを低く設定したprognosis based outcome analysisが用いられているが,治療法に迷う症例における外科的治療の優位性は証明できなかった25).手術手技の多様性,救急現場で生命に関わる治療法選択の無作為割付は倫理的,統計学的に困難であることも外科治療の効果の解析を困難にしている26)

 近年,より低侵襲とされる内視鏡手術が施行される機会が増えているが,われわれは止血の確実性を優先し,現在でも被殻出血の外科的治療は急性期に行う開頭血腫除去術のみで対処している2,17,19,20).今回,被殻出血における開頭血腫除去術の治療成績を検討した.対照群を設定していないobservational studyだが,単一施設で施行された手術手技にばらつきの少ないデータは他の治療との比較を行う際の参考になると思われる2,27).本論文ではtranssylvian transinsular approachによる血腫除去の手術法について概略を記述した.転帰は当院退院時と発症6カ月後に理学療法士など脳神経外科医以外による客観的なactivities of daily living(ADL)の評価を行った.

参考文献

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掲載誌情報

出版社:株式会社医学書院

電子版ISSN:1882-1251

印刷版ISSN:0301-2603

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