显微镜下经侧裂-岛叶入路清除基底节区出血的手术治疗及预后相关因素分析

Microsurgical treatment and prognostic factors analysis of basal ganglia hemorrhage via transsylvian fissure-insular approach

目的探讨显微镜下经侧裂-岛叶入路清除基底节区出血的手术疗效及预后相关因素。方法回顾性分析我科自2017年7月至2019年7月收治的35例高血压性基底节出血患者的手术疗效及远期预后,同时收集患者年龄、性别、血肿量、术前GCS评分及中性粒/淋巴细胞比值等资料,探讨其与预后相关性。结果 35例基底节出血患者术前CT检查提示基底节壳核出血19例,外囊出血8例,内囊出血8例,其中6例破入脑室;术后血肿完全清除22例,近全清除9例,大部分清除4例;3~6个月GOS评分预后评定,死亡2例,植物生存4例,需要他人照顾8例,中残18例,能工作、生活3例;预后良好组(GOS评分4~5分)血肿量(28.21±5.14)、GCS评分(11.08+1.21)及中性粒/淋巴细胞比值(7.56±0.46)与预后不良组(GOS评分1~3分)血肿量(36±3.14)、GCS评分(7.21±0.98)及中性粒/淋巴细胞比值(10.87±0.76)存在明显差异(P<0.01)。结论经侧裂-岛叶入路清除基底节血肿具有路径段、创伤小、疗效确切等优点,但对显微外科操作技术要求较高;术前血肿量、GCS评分及中性粒/淋巴细胞比值可作为预测患者远期预后的指标之一。

Objective To investigate the surgical effect and prognostic factors of removing basal ganglia hemorrhage via transsylvian fissure-insular approach under the microscope.Methods Retrospective analysis of the surgical effect and long-term prognosis of 35 patients with hypertensive basal ganglia hemorrhage treated in our department from July 2017 to July 2019,and the age,gender,hematoma volume,preoperative GCS score and Neutrophil/lymphocyte ratio and other data were used to explore its correlation with prognosis.Results Preoperative CT examination of 35 patients with basal ganglia hemorrhage revealed 19 cases of basal ganglia nucleus hemorrhage,8 cases of outer capsule hemorrhage,8 cases of inner capsule hemorrhage,6 of which broke into the ventricle;22 cases of hematoma were completely removed after surgery,and nearly all were removed.9 cases,most of which were cleared in 4 cases;GOS score prognostic evaluation in 3 to 6 months,2 cases of death,4 cases of plant survival,8 cases requiring care of others,18 cases of disabled people,3 cases of working and living;good prognosis group(GOS score 4 to 5) Hematoma volume(28.21±5.14),GCS score(11.08 + 1.21) and neutrophil/lymphocyte ratio(7.56±0.46) and hematoma volume in poor prognosis group(GOS score 1 to 3)(36±3.14),GCS score(7.21±0.98) and neutrophil/lymphocyte ratio(10.87± 0.76) were significantly different(P<0.01).Conclusion The removal of basal ganglia hematomas via transsylvian fissure-insular approach has the advantages of path segment,less trauma,and accurate curative effect,but it has higher requirements for microsurgical operation techniques;preoperative hematoma volume,GCS score and neutrophils/lymphocyte ratio can be used as one of the indicators to predict the long-term prognosis of patients.