脑出血外科治疗存在的问题及未来发展方向

doi:10.3969/j.issn.1673-5765.2025.12.002

摘要/Abstract

摘要： 脑出血是一种常见的脑血管疾病，具有高致死率和高致残率，外科治疗在其救治中占据重要地位，但目前仍面临诸多困境。传统开颅手术存在创伤与获益失衡的问题，对深部血肿疗效欠佳；微创手术具备一定优势却受限于技术标准化不足及证据强度弱等问题，尚未形成普适、高效的方案。另外，城乡医疗资源差异也导致了脑出血外科治疗效果不均衡。为提高脑出血外科治疗效果，需精准把握手术适应证，构建术前综合评估系统，并结合人工智能等新兴技术实现个性化治疗；通过手术机器人等新兴技术提升微创血肿清除的效率与安全性；借助远程手术、轻量化设备及云端协作等推动先进治疗理念和技术向基层医疗机构普及；强化多学科协作与分级诊疗联动，实现脑出血的高效外科救治。未来，随着多方面技术的深度融合，脑出血外科治疗将迈向更精准、普惠、优质的阶段。

关键词: 脑出血; 外科治疗; 微创手术; 手术机器人; 技术推广

Abstract: Intracerebral hemorrhage is a common cerebrovascular disease characterized by high mortality and high disability rates. Surgical treatment plays a crucial role in its management, yet it still faces multiple challenges. Conventional craniotomy is plagued by the issue of imbalance between trauma and benefits, with poor efficacy for deep-seated hematomas. Although minimally invasive surgery has certain advantages, it is limited by insufficient standardization and weak evidence support, failing to form a universally applicable and efficient protocol. Additionally, disparities in medical resources between urban and rural areas lead to the uneven outcomes of surgical treatment for intracerebral hemorrhage. To improve the efficacy of surgical treatment for intracerebral hemorrhage, it is essential to accurately define surgical indications, establish a comprehensive preoperative evaluation system, and integrate emerging technologies such as artificial intelligence to achieve personalized treatment. The efficiency and safety of minimally invasive hematoma evacuation should be enhanced through emerging technologies such as surgical robots. Advanced treatment concepts and technologies need to be extended to grassroots medical institutions via telesurgery, lightweight devices, and cloud-based collaboration. Multidisciplinary collaboration and linkage with hierarchical medical systems should be strengthened to realize efficient surgical treatment of intracerebral hemorrhage. In the future, with the in-depth integration of various technologies, surgical treatment for intracerebral hemorrhage will move toward a more precise, accessible, and high-quality stage.

Key words: Intracerebral hemorrhage; Surgical treatment; Minimally invasive surgery; Surgical robot; Technology promotion

中图分类号:

王乔, 张东. 脑出血外科治疗存在的问题及未来发展方向[J]. 中国卒中杂志, 2025, 20(12): 1480-1486.

WANG Qiao, ZHANG Dong. Current Challenges and Future Directions in the Surgical Treatment of Intracerebral Hemorrhage[J]. Chinese Journal of Stroke, 2025, 20(12): 1480-1486.

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