超早期小骨窗经侧裂入路微侵袭治疗基底节血肿

Ultra early minimal invasive therapy for intracerebral hemorrhage from basal ganglia by small craniotomy lateral fissure approach

目的探讨超早期小骨窗经侧裂入路微侵袭治疗基底节血肿的效果。方法对53例基底节血肿的病人采取侧裂投影直切口,小骨窗经侧裂入路手术清除血肿。结果术后10h意识状况:42例神志清楚,7例较术前好转,4例无改善;24内复查CT,残余血肿量与术前比较。血肿清除80%以上有40例,50～80%者有9例,50%以下和超过原血肿量共3例,术后72h复查CT,脑水肿引起的占位效应与传统手术相比非常轻微;死亡7例,死亡率达13·21%;术后3～6个月随访,按ADL分级进行测评:Ⅰ级4例(7·55%);Ⅱ级11例(20·75%);Ⅲ级22例(41·51%);Ⅳ级7例(13·21%);Ⅴ级2例(3·77%)。结论超早期小骨窗经侧裂入路有视野好便于彻底清除血肿、创伤小、对脑组织损伤轻微和手术时间短等优点;术后脑水肿轻微,病人恢复快,明显提高预后。

Objective To explore the effects of ultra early minimal invasive therapy for intracerebral hemorrhage from basal ganglia by small craniotomy lateral fissure approach. Methods 53 patients with intracerebral hemorrhage from basal ganglia were subjected to surgical treatment by straight scale incision on the projection of lateral fissure and small craniotomy lateral fissure approach. Results 10 hours after the operation ,all patients, were observed on consciousness state, consciousness in 42 cases , improving of consciousness in 7 cases ,inefficient in 4 cases. CT re- examination within 24 hours of posting- operation results showed 80% aspiration of hematoma in the primary size in 40 cases,50-80% aspiration in 9 cases and less than 50% and more than the primary size of hematoma in 3 cases in total. CT re-examination 72 hours of posting-operation results occupying effection by enceph- aledema were extremely little. 7 cases were dead , the mortality was 13.21 %. The post-operate follow-up of 3 -6 months showed 4 cases were subjected to Grade Ⅰ （7.55 %）, 11 cases for Ⅱ Grade（20. 75 %）, 22 cases for Grade Ⅲ （41.51%）, 7 cases for Grade Ⅳ （13.21%） ,2 cases for Grade Ⅴ （3.77 %） by the ADL grading scale. Conclusion Transsylvian approach is very directly and possess fine operating field, easy to aspiration for hematoma, and brain injury caused by approach is very light, so occupying effection by encephaledema are extremely little, patients recover quickly, and obviously improv in prognosis.