个体化选择手术方式治疗基底节出血156例疗效分析

The efficacy of the personalized choice of different surgical approach on evacuation of basal ganglia hemorrhage

目的探讨应用个体化原则选择不同手术方式治疗基底节出血,分析不同手术方式治疗的效果。方法回顾性分析2010年1月至2012年12月156例基底节出血患者手术资料,其中小骨窗显微血肿清除术(A术式)90例,改良微创血肿腔置管抽吸引流术(B术式)66例,比较两种手术方式的优缺点与适应证。结果 B术式的手术时间、手术出血量、住院时间均少于A术式,而血肿清除率低于A术式,差异有统计学意义(P<0.05);轻型基底区出血采用两种手术方式治疗后好转率、并发症发生率、术后6月疗效比较差异无统计学意义(P>0.05);中型和重型基底节区出血采用微创血肿清除术好转率、并发症发生率低于钻孔引流术,术后6月疗效好,差异有统计学意义(P<0.05)。结论两种手术方式各有优缺点与适应证,术前合理评估患者病情,个体化选择合适的手术方式,能减少患者并发症,提高治愈率,降低残疾率。

Objective To investigate the application of principles of personalized choice of different surgical approach to the evacuation of basal ganglia hemorrhage, and analyze the therapeutic effects of different surgical methods. Methods Surgical data of 156 cases with basal ganglia hemorrhage were retrospectively analyzed. Of these patients ,90 cases were received a microsurgical evacuation of hematoma through small skull window（ operation type A）, and 66 cases received a modified minimally invasive hematoma cavity catheter drainage（ operation type B）. Advantages and disadvantages and indications of the two operation methods were compared. Results The operative time ,blood loss and hospital stay in patients by using the operation type B were less than that by using the operation type A（ P 〈 0. 05 ）. For cases with light basal ganglia hemorrhage, there was no significant difference in the improvement rate after treatment,complication and curative rate after 6 months of treatment between the two types of operations. For cases with moderate or severe basal ganglia hemorrhage, the improvement rate after treatment and the complication rate of the operation type B were lower than that of the operation type A, and the curative rate after 6 months of treatment of the operation type B was better than that of operation type A （ all P 〈 0.05）. Conclusion The two kinds of operation modes have their own advantages and disadvantages and indications. Reasonable preoperative assessment of the patients＇ medical condition is essential for the individualized selection of appropriate operation pro-cedure. It is able to improve the cure rate, and reduce the complications and disability rate.