经侧裂-岛叶入路显微手术治疗脑出血

Efficacy study of cerebral hemorrhage by microsurgery via transsylvian fissure-insular approach

目的探讨经侧裂-岛叶入路显微手术治疗脑出血的疗效。方法将100例因脑出血行开颅手术清除血肿的患者随机分为对照组和观察组,每组50例。对照组采用常规颞叶中回切开皮层清除血肿;观察组采用扩大翼点入路经侧裂-岛叶入路清除血肿。观察2组患者术后精神障碍、癫痫、偏盲、脑梗死、脑脊液漏、皮下积液、感染等并发症及后遗症的发生情况;对比术后第14、30和60天时患者美国国立卫生院神经功能缺损评分(NIHSS),评价患者神经功能缺失情况,并进行比较分析。结果术后第14、30和60天NIHSS评分均较术前明显降低,差异有统计学意义(P<0.05);观察组在第14、30和60天时NIHSS评分的降低值(均为与入院时NIHSS评分值比较)均较对照组大,差异有统计学意义(P<0.05)。术后2组患者脑脊液漏、皮下积液、术后感染等并发症发生情况比较差异无统计学意义(P>0.05);观察组术后精神障碍、癫痫、偏盲、脑梗死等发生例数均少于对照组,差异有统计学意义(P<0.05)。结论经侧裂-岛叶入路显微手术治疗脑出血是一种损伤小、疗效好、并发症少的治疗方法。

Objective To study the therapeutic effect of cerebral hemorrhage by microsurgery via transsylvian fissure- insular approach. Methods A total of 100 patients with cerebral hemorrhage who were accepted microneurosurgery were ran- domly divided into observation group and control group, 50 cases in each group. In the surgery, the cases in control group were treated with conventional cut medial temporal lobe cortex to remove haematoma and the cases in observation group were treated with microsurgery via transsylvian fissure-insular approach. The complications of mental disturbance, epilepsy, hemianopsia, cerebral infarction, cerebrospinal fluid leakage, subcutaneous fluid and postoperative infection were observed. The national insti- tute of health stroke scales（NIHSS） of the patients were compared on the postoperative 14th ,30th and 60th day. And the neuro- function deficit was evaluated to do the comparative analysis. Results On the 14th ,30th and 60th day after the operation,the values of NIHSS in two groups were both significantly lower than those before the operation（ P 〈 0.05 ）. The reduced value of the NIHSS on the 14th ,30th and 60th day in the observation group was more than that in the control group, there was significant difference between the two groups（ P 〈 0.05 ）. The complications of cerebrospinal fluid leakage and subcutaneous fluid of post- operative patients had no significant difference between the two groups （ P 〉 0.05 ）. The number of patients who had mental dis- turbance, epilepsy, hemianopsia and cerebral infarction in the observation group was significantly lower than that in the control group after surgery（ P 〈 0.05 ）. Conclusion Microsurgical treatment via transsylvian fissure-insular approach for cerebral he- matomas is a kind of minimally invasive method with less damage, better effects and less complications.