锁孔外侧裂入路治疗高血压脑基底节出血的临床应用

The research of microsurgical treatment approached from the lateral fissure keyhole for hypertensive cerebral hemorrhage in basal ganglia

目的探讨经锁孔外侧裂入路显微手术治疗高血压脑基底节出血的临床应用价值。方法回顾性分析29例高血压脑基底节出血病人的临床资料(A组),全部采用翼点锁孔入路在显微镜下解剖外侧裂,经岛叶皮层清除血肿。同一时期采用大骨瓣开颅手术方式的高血压脑基底节出血病人35例,列为B组。比较两组病人的手术时间、术中出血量、住院时间、病死率、出院时及随访1年后的日常生活能力评分。结果A组对比B组,手术时间、术中出血量、住院时间明显减少(P<0.05),住院病死率、1年后病死率以及出院时病人恢复良好率无显著差异(P>0.05),但是1年后A组病人生活能力恢复良好率比B组要高(P<0.05)。结论经锁孔外侧裂入路治疗高血压基底节出血具有手术时间短、术中出血量少、手术创伤小、利于患者恢复的优点。

Objective To explore the effect of microsurgical treatment approached from the lateral fissure keyhole for hypertensive cerebral hemorrhage in basal ganglia. Methods Clinical data of 29 cases of hypertensive cerebral hemorrhage in basal ganglia was retrospectively analyzed. All the patients were treated by the surgery approached from lateral fissure of keyhole under the microscopic anatomy, through the insular cortex, removing hematoma （ group A）. At the same time, 35 hypertensive cerebral hemorrhage patients underwent large bone section operation （ group B）. The operating time, bleeding quantity, hospitalization time, mortality rate, ability of daily life score when discharging from hospital and after a year were recorded and compared between the two groups. Results Compared with group B, group A had shorter operating time and hospitalization time and smaller bleeding quantity （ P 〈 0.05 ）. Mortality rate in hospital and after a year and ability of daily life score at hospital discharge between the two groups were similar （ P 〉 0.05 ） , but one year good recovery rate was higher in group A than that in group B （ P 〈 0.05 ）. Conclusion The microsurgical treatment approached from the lateral fissure keyhole for patients with hypertensive cerebral hemorrhage in basal ganglia had the advantages of short operating time, small bleeding quantity, little trauma and better patient recovery.