经外侧裂-岛叶入路与经皮质造瘘术对基底核脑出血周围水肿带的影响

Influence of transsylvian-insular and transcortical ostomy on edema band around basal ganglia hemorrhage

目的比较经外侧裂-岛叶入路与经皮质造瘘术对高血压性基底核区脑出血周围水肿带的影响。方法回顾性分析63例基底核区高血压性脑出血病人的临床资料,其中行经外侧裂-岛叶入路手术33例(经外侧裂-岛叶入路手术组),行经皮质造瘘术30例(经皮质造瘘手术组)。结果与经皮质造瘘手术组比较,经外侧裂-岛叶入路手术组术后7 d血肿周围水肿体积、术后48 h残余血肿量均明显减小(P<0.05),术后7 d GCS评分明显升高(P<0.05),住院时间明显缩短(P<0.05)。经外侧裂-岛叶入路手术组血肿全部清除21例,大部分清除12例;术后再出血1例,癫疒间3例,脑积水2例。经皮质造瘘手术组血肿全部清除12例,大部分清除18例;术后再出血2例,癫疒间5例,脑积水5例,失语3例。结论显微镜下经外侧裂-岛叶入路手术能明显减轻脑出血周围水肿,可作为高血压性脑出血手术治疗的首选术式。

Objective To compare the influences of the surgery via ssylvian-insutar approach and tmnscortical ostomy on edema band around hypertensive basal ganglia hemorrhage. Methods Clinical data of 63 patients with hypertensive basal ganglia hemorrhage were analyzed retrospectively. The surgery via sylvian-insular approach was performed in 33 patients （SIA group） and transcortical ostomy in 30 （TCO group）. Results Compared with TCO group, the edema volumes around the hematoma 7 d after operation and residual hematoma volumes 48 h after operation were more significantly reduced （P 〈 0.05）, GCS scores 7 d after operation more significantly increased （P 〈 0.05）, and the hospital stays more significantly shortened in SIA group （P 〈 0.05）. Total hematoma removal was achieved in 21 patients and subtotal removal in 12, while postoperative rebleeding occurred in 1 patient, epilepsy in 3 and hydrocephalus in 2 in SIA group. Total hematoma removal was achieved in 12 patients and subtotal removal in 18, while postoperative rebleeding occurred in 2 patients, epilepsy in 5 and hydrocephalus in 5 and aphasia in 3 in TCO group. Conclusion The surgery via sylvian-insular approach under microscope can obviously relieve the edema around hemorrhage, and be considered as the first choice for surgical treatment for hypertensive cerebral hemorrhage.