基底节脑出血CT分型对手术方式及手术效果的影响

Influence of hypertensive striatocapsular hemorrhage from surgical method to surgical operation effect according to a new classification method by CT

目的:探讨基底节区高血压性脑出血CT分型对患者手术方式及手术效果的影响。方法:选取25例基底节区高血压性脑出血患者为实验组,依据血肿在矢状位上与基底节的关系分为:前上区型、前下区型、后上区型、后下区型和混合型,依据血肿类型选择手术入路及岛叶造瘘点。31例常规手术入路未特别选定造瘘点的患者为对照组。比较两组的血肿清除率、再出血率、远期生存质量等。结果:术后清醒时间、平均住院时间实验组为(3.02±5.16)d、(16.38±5.42)d,对照组为(4.13±6.29)d、(18.26±7.09)d,两组相比无统计学差异(P>0.05)。血肿清除>90%的例数分别为23/25(92.0%)和20/31(65.0%),实验组优于对照组(P=0.035)。再出血率分别为1/25(4.0%)与9/31(29.0%),实验组少于对照组(P=0.037)。两组ADL评分分级Ⅰ～Ⅴ级分别为9、7、5、3、1例和5、8、8、5、5例,实验组同样优于对照组(P=0.046)。结论:根据矢状位位置关系对血肿进行分型,选择手术方法,可提高血肿清除率,减少术后再出血,提高患者远期生活功能恢复程度,提高生活质量。

Objective To investigate the influence of hypertensive striatocapsular hemorrhage from surgical method to surgical operation effect according to a new classification method by CT. Methods 25 patients with the hypertensive striatocapsular hemorrhage was experimental group （EG）, according to position with the basal ganglia on the sagittal view, the hematomas in these group were divided into five types： （1） the anterior-superior type; （2） the anterior-inferior type ; （3） the posterior-superior type ; （4） the posterior-inferior type ; （5） the mixed type. The surgical approach and the fistula point on insula were chosen according to the new classification method. At the same time, 31 patients were in control group （CG）, and they were treated as tradition, without selecting fistula point on insula. The clinical data was compared between the two groups. Results The postoperative awake time of EG and CG was （3.02±5.16） days and （4.13 ± 6.29） days, there was not statistically significant between the two group （P 〉 0.05）. The average length of stay of EG and CG was （16.38 ± 5.42） days and （18.26 ±7.09） days, there was not statistically significant between the two group （P 〉 0.05） too. Hematoma remove 90% rate was 23/25 （92.0%）and 20/31 （65.0%）, EG was better than CG （P = 0.035 ）, the bleeding rate was 1/25 （4.0%） and 9/31 （29.0%）, EG was also better than CG（P = 0.037）, the number of patient of each grade by the activities of daily living （ADL） of EG was 9,7,5,3,1 ; the number of CG was 5,8,8,5,5, the EG was superior to the CG （P = 0.046）. Conclusions To select the surgical method according to the classification on the sagittal view, the hematomas will be removed more, and it will be helpful for reduce the bleeding and improve the life quality of patients.