目的探讨微创清除术治疗高血压幕上脑出血的手术时机与安全性及其与疗效的关系。方法 4 7例中型高血压脑出血患者随机分为两组 :A组 2 1例 ,在发病 2 4小时内进行微创颅内血肿清除治疗 ;B组 2 6例 ,在发病 1周后给予微创颅内血肿清除治疗。两组均采用YL 1型针形碎吸器进行微创颅内血肿清除 ,并配合常规治疗 ;最后对两组患者的再出血发生率、近期疗效 (神经功能缺损评分 ,FAM评分 )和远期疗效进行比较。结果发病后 1个月FAM评分 ,A组为17.6 2± 5 .0 3,B组为 11.36± 3.4 7;发病后 6个月Barthel指数A组为 6 5 .6 9± 10 .17,B组为 80 .33± 9.2 1;再出血发生率A组为 2 8.5 7% ,B组为 3.85 %。三者比较均有显著差异 (P <0 .0 1)。结论微创术作为一种简单易行的治疗高血压幕上脑出血的方法 ,对于中型脑出血患者于发病 1周后手术疗效更佳 ,且再出血发生率低。 Objective To investigate the timing and safety of minimally invasive surgical treatment of supratentorial intracerebral hemorrhage and its relationship with the curative effect. Methods Twenty-seven patients with hypertensive intracerebral hemorrhage were randomly divided into two groups: 21 cases in group A, which were treated with minimally invasive intracranial hematoma removal within 24 hours after onset. In group B, 26 cases were given micro-intracranial hematoma after 1 week Create intracranial hematoma removal treatment. In both groups, YL-1 needle-typed respirator was used for the minimally invasive intracranial hematoma removal, and combined with conventional treatment. Finally, the incidence of rebleeding, short-term efficacy (neurological deficit score, FAM score) and long- Compare. Results One month after onset, the FAM score was 17.6 2 ± 5 .0 3 in group A and 11.36 ± 3.4 7 in group B; Barthel index A was 6 59.6 10 ± 17 in group B at 6 months after onset Was 80.33 ± 9.21. The incidence of rebleeding was 8.57% in group A and 3.85% in group B, respectively. The three were significantly different (P <0. 01). Conclusion Minimally invasive surgery as a simple and easy method of treatment of hypertensive supratentorial intracerebral hemorrhage, for patients with intracerebral hemorrhage in the incidence of surgery after 1 week better, and the incidence of rebleeding is low.