脳出血の手術経験

THE EXPERIENCES IN THE SURGICAL TREATMENT OF THE CEREBRAL HAEMORRHAGES

I．はじめに

　脳血管障害による死亡は国民死亡の第1位を占め，そのなかでも秋田県は昭和38年の統計によれば長野県についで第2位であり，死亡率（対10万）は全国平均171.1に対して251.9を数える（第2図）。さらに第1図のように全国平均死亡率の上昇に伴い，秋田県でも全国1,2位を争いつつ上昇している。脳血管障害患者の分類と頻度については，勝木内科あるいは文部省研究班の統計によると脳出血は脳硬塞に比して少ないが，本院の統計では脳出血が多い（第1,2表）。しかも脳出血に死亡率が高い。以上の事実に対して私どもは，昭和39年初めより本症に対する従来の治療方法に反省を加え，積極的治療，すなわち手術療法を始め，本症患者の救命にあたつてきた。

Eleven cases of cerebral haemorrhages were treated surgically in the method of evacuation of haematoma in recent one and a half year, resulting in 6 cases of improvement and 5 cases of death in which one case died after improvement and another case after long time of unconsciousness.

The criteria of indication for operation were decided as follows : 1) Disturbance of consciousness must be progressive, Cerebral haemorrhage must be suspect-ed by physical examination, 3) The location of hae-matoma must be detected by cerebral angiography, 4 General condition must be good enough to endure the surgical procedure.

Generally speaking, the disturbances of consciousness were slow in progress in the cases of improvement, but rapid and severe in the cases of death. Almost all cases who died after surgical procedure were accom-panied by haemorrhages of brain stem which had no indication for operation in the present time. The sur-gical procedure should be performed in the early sta-dium before the development of irriversible changes in the cerebral parenchym, because the surgical opera-tion had no effect on the improvement of conscious-ness after long period of unconsciousness

The problems in diagnosis and many complications associating with this operation also discussed in this report.