左侧基底节区高血压脑出血的术式选择及功能保护

The surgical approach selection and function protection for hypertensive intracerebral hemorrhage of the left-sided basal ganglia

目的探索左侧基底节区高血压脑出血的术式选择策略及功能保护技巧。方法回顾性分析65例左侧基底节区高血压脑出血手术治疗病例。其中传统颞瓣开颅经皮质入路34例;翼点开颅经外侧裂-岛叶入路19例;直切口小骨窗开颅12例。结果血肿完全清除19例,近全清除31例,大部清除13例,再出血后两次手术清除2例。随访6个月～2年,GOS评分优18例,轻残29例,重残12例,植物状态3例,死亡3例。结论应根据术前病情分级、血肿CT分型、患者年龄等因素合理选择不同的手术方式。术中微侵袭操作、充分减压以及重要血管保护是取得良好预后的关键因素。

Objective To explore the strategy of surgical approach selection and the techniques of function protection for hypertensive intraeerebral hemorrhage of the left-sided basal ganglia. Methods The clinical data were retrospectively analysed in 65 patients with hypertensive intracerebral hemorrhage of the left-sided basal ganglia received surgical treatment. Among them, 34 were operated for hematoma evacuation by the traditional temporal craniotomy-transcortical approach, 19 were operated by the pterional craniotomy-transsylvian approach, 12 were operated by the small bone flap craniotomy. Results Total evacuation of hematoma was a- chieved in 19 cases, nearly total evacuation was achieved in 31 cases, sub-total evacuation in 13 cases, rebleeding and then reoperation in 2 cases. Follow-up 6 months to 2 years, good recovery was made in 18 cases, moderate disability in 29 cases, severe disability in 12 cases, persistent vegetative state in 3eases and death in 3 cases, according to the Glasgow Outcome Scale （GOS）. Conclusion The surgical approach selection should be based on the grading of neurological status, CT classification for hematoma and age of patients. The application of minimally invasive techniques during surgery, sufficient decompression and the vital vessel protection are key factors to achieve good outcome.