目的 :探讨不同手术方法对高血压脑出血的治疗效果。方法 :对高血压脑出血 81例 (壳核和外囊出血 49例 ,丘脑出血 13例 ,皮质下出血 12例 ,桥脑出血 2例 ,小脑半球出血 5例 ,其中 12例出血破入脑室 )患者 ,采用大骨瓣开颅血肿清除 32例 ,小骨窗开颅清除血肿 +尿激酶保留冲洗 41例 ,神经内窥镜辅助小骨窗清除血肿 8例。结果 :大骨瓣开颅组死亡 8例 ,优良生存 7例 ;小骨窗开颅 +尿激酶冲洗组死亡 9例 ,优良生存 10例 ;内窥镜辅助组无死亡 ,优良生存 5例。结论 :主张对高血压脑出血特别是外囊、壳核及皮质下血肿应早期手术 ,用神经内窥镜辅助开颅手术可更彻底清除血肿 ,同时可解决深部止血困难问题 Objective: To explore the therapeutic effect of different surgical methods on hypertensive intracerebral hemorrhage. Methods: Eighty-one patients with hypertensive intracerebral hemorrhage (49 cases of putamen and epicardial hemorrhage, 13 cases of thalamic hemorrhage, 12 cases of subcortical hemorrhage, 2 cases of pontine hemorrhage, 5 cases of cerebellar hemisphere hemorrhage, 12 cases of hemorrhage broke into ventricles) Patients, the use of large craniotomy craniectomy 32 cases, small craniotomy craniotomy remove hematoma + urokinase retention rinse in 41 cases, neuroendoscope assisted small bone window clear hematoma in 8 cases. Results: In the craniotomy group, 8 died and 7 survived. In the open skull and urokinase group, 9 died and 10 survived. In the endoscopic assisted group, 5 died. Conclusion: It is advocated that hypertensive intracerebral hemorrhage, especially the outer capsule, putamen and subcortex hematoma should be early surgery, with endoscopic neurosurgical craniotomy can be more complete removal of hematoma, and can solve the problem of deep hemostasis