小骨窗经侧裂入路显微外科治疗中重度高血压基底核区脑出血的临床分析

Clinical Analysis of Microsurgery with Small Bone Flap Craniotomy and Lateral Fissure Approach in Treatment of Moderate and Severe Hypertensive Cerebral Hemorrhage in Basal Ganglia Region

目的探讨小骨窗经侧裂入路显微外科手术治疗中重度高血压基底核区脑出血的临床疗效。方法根据日本脑卒中外科治疗协作研究提出的高血压脑出血分级标准进行分级。对56例3～5级中重度高血压基底核区脑出血患者采用小骨窗经侧裂入路显微外科手术清除血肿的疗效进行分析。结果 56例中3级9例,4a级15例,4b级24例,5级8例,血肿量40～120ml,平均67.7ml。53例术后第2天复查CT,17例血肿完全清除,23例血肿清除率>85%,6例血肿清除率60%～85%,7例术后再出血。死亡8例,病死率14.29%。术后3～6个月对存活者进行随访,按照日常生活能力(ADL)评分:Ⅰ级7例,Ⅱ级18例,Ⅲ级12例,Ⅳ级6例,Ⅴ级5例。全组Ⅰ～Ⅲ级良好率66.07%。结论小骨窗开颅经侧裂入路显微外科手术治疗中重度高血压基底核区脑出血是一种微创、有效的手术方式,同样适用于出血量大、术前出现脑疝的患者。

Objective To investigate the effect of microsurgery with small bone flap craniotomy（SBFC） and lateral fissure approach （LFA） in treatment of moderate and severe hypertensive cerebral hemorrhage （HCH） in basal ganglia region （BGR）. Methods The clinical data of 56 cases of moderate and severe HCH in BGR were reviewed. The degree of neurologie severity was defined on admission according to the NGs ranging from 1 to 5, adopted by the Japanese Cooperative Study on Stroke Surgery. All patients were treated by mi- crosurgery with SBFC and LFA. Results In all 56 patients,NG3 was found in 9 cases, NG4a in 15 cases, NG4b in 24 cases, NG5 in 8 eases. Hematoma volume was from 40 to 120ml, with an average of 67.7ml. 53 patients had computed tomography（CT） scan on the sec- ond day after postoperative,of whom 17 cases of hematoma completely cleared, 23 cases cleared over 85% , 6 cases cleared 60% to 85% , 7 cases had rebleeding, 8 cases were dead, with mortality was 14.29% . The patients survived were followed up 3 to 6 month after postop- erative,and were evaluated by activities of daily living（ADL） , in which grade I was found in 7 cases,grade Ⅱ in 18 cases,grade Ⅲ in 12 cases,grade IV in 6 case, gradeV in 5 cases. The favorable rate （ Grade I to Ⅲ ） was 66.07% . Conclusion Mierosurgery with SBFC and LFA evacuation of hematoma in BGR is a kind of minimally invasive and effective procedure. It is also suitable for the patient who was hematoma massive or present brain hernia preoperatively.