超早期小骨窗显微手术经外侧裂-岛叶入路治疗基底节脑出血疗效观察

Observation of clinical efficacy of super-early small bone window microsurgery via lateral fissure-insular approach on basal ganglia hemorrhage

目的 探讨高血压性基底节脑出血患者应用超早期小骨窗显微手术经外侧裂-岛叶入路治疗的临床效果.方法 对我院2011-11-2013-02收治的应用超早期小骨窗显微镜下经外侧裂-岛叶入路治疗的52例高血压性基底节脑出血患者的临床资料进行回顾性分析.结果 本组患者平均手术时间（55.5±10.5）min,术后24 h 40例患者血肿清除率在90%以上,10例患者血肿清除率在80%～90%,2例患者血肿清除率在70%～80%.术后有2例患者发生再出血,行去骨瓣减压术和开颅血肿清除术.预后6个月进行随访,持续昏迷者1例,死亡1例.结论 高血压性基底节脑出血患者应用超早期小骨窗显微手术经外侧裂一岛叶入路治疗,减轻了血肿对周围脑组织的压迫,脑组织损伤轻微,最低程度上降低了血肿周围脑组织的继发性损害,有效改善了患者术后神经功能的恢复效果.

Objective To investigate the clinical efficacy of super-early small bone window microsurgery by lateral fissureinsular approach on patients with hypertensive basal ganglia hemorrhage. Methods 52 cases of hypertensive basal ganglia hemorrhage patients in the Affiliated Hospital of North Sichuan Medical College from November 2011 to February 2013 were treated by early application of ultra small bone window under a microscope by lateral fissure-insular approach and the clinical data were retrospectively analyzed. Results The mean operative time was （55.5 ± 10.5） minutes, the hematoma clearance rate of 40 patients was 90~/oo after 24 hours, which was 80% to 90% in 10 patients and 70% to 80% in 2 patients. Two patients had postoperative bleeding, and treated by decompressive craniectomy and hematoma evacuation. All the patients were followed up for 6 months, 1 case was in persistent coma, and 1 patient died. Conclusion For treatment of hypertensive patients with basal ganglia hemorrhage, super-early small bone window microsurgery via lateral fissure-insular approach can alleviate the hematoma on the surrounding brain tissue with mild brain injury, can maximumly reduce secondary damage of brain tissue around the be matoma, and effectively improve the recovery of neurological function.