不同时期小骨窗经侧裂-岛叶入路手术治疗高血压基底节脑出血

Different time treatment via small bone flap craniotomy through lateral fissure approach for hypertensive basal ganglia hemorrhage

目的探讨不同时期小骨窗经侧裂-岛叶入路显微手术治疗高血压基底节脑出血的疗效。方法回顾性分析2009年1月至2011年10月青岛市立医院神经外科收治的采用小骨窗开颅,显微镜下经侧裂-岛叶入路清除血肿的高血压基底节脑出血患者115例,其中男71例,女44例;术前格拉斯哥昏迷评分(GCS)13~15分的12例,9~12分的33例,5~8分的70例;根据治疗时间的不同分为早期(发病7~24 h内)手术组(82例)和晚期(24 h^5 d)手术组(33例)。对比分析各组手术血肿清除率、再出血率、死亡率和手术后6个月随访,按照日常生活能力(ADL)分级进行疗效评价。分别采用卡方检验和t检验进行统计学分析。结果早期手术组与晚期手术组的出血量无统计学差异。早期手术组血肿大部以上清除76例(92.68%)、再出血8例(9.76%)、死亡6例(7.31%)、术后6个月ADL良好率76.82%(63/82)。晚期手术组血肿大部以上清除27例(81.81%)、再出血10例(30.30%)、死亡14例(42.42%)、术后6个月ADL良好率24.24%(8/33)。统计分析两组再出血率、死亡率及术后ADL分级具有显著性差异(χ2=7.5245、20.1866、13.3942,P均<0.05)。结论早期小骨窗侧裂-岛叶入路显微手术治疗高血压基底节脑出血具有创伤小、神经功能恢复快、预后好的优点。

Objective To explore the effects of microsurgical treatment via small bone flap craniotomy through lateral fissure and insular lobe approach for hypertensive basal ganglia hemorrhage during its early period. Methods Retrospective analysis of cases of 115 patients who received microsurgical treatment via small bone flap craniotomy through lateral fissure approach for hypertensive basal ganglia hemorrhage from January 2009 to October 2011 in the Department of Neurosurgery, Qingdao Municipal Hospital. Of the 115 patients,71 were male and 44 were female. In terms of pre-operation GCS scores, 12 patients were evaluated between scores of 13 and 15,33 patients between scores of 9 and 12 ,and 70 patients between scores of 5 and 8. In line with the treatment time,the 115 cases were divided into two groups：early period treatment group（7 to 24 hours after incidence）of 82 cases and later period treatment group（24 hours to 5 days after incidence）of 33 cases. Contrastive analysis was made in such aspects as haematoma evacuation rate, rebleeding rate, death rate, and follow-up visits 6 months after operation. And therapeutic evaluation was made in line with the patients activites of daily living （ADL）. Chi-square tests and t tests were used for statistical analysis. Results There was no statistical difference in the amount of bleeding of the two groups. In the early period treatment group,76 （92. 68% ）patients＇ hematoma were mostly cleared or evacuated, and there were 8 cases（9. 76% ）of rebleeding,and 6（7. 31% ）deaths. Six months after operation,76. 82% of the patients（63/82） of the early period treatment group were moderately recovered in terms of ADL. In the late period treatment group,27 patients＇（ 81.81% ）hematoma were mostly cleared or evacuated, and there were 10 eases of rebleeding（30.30% ） and 14 deaths（42.42% ）. Six months after operation,24.24% of the patients （ 8/33 ） of the late period treatment group were moderately recovered in terms of ADL. Statistical analysis of the two groups shows obvious differences in terms of rebleeding, death rate and post-operation ADL（x2 = 7. 5245,20. 1866,13. 3942, all P 〈 0. 05 ）. Conclusion Early microsurgieal treatment via small bone flap craniotomy through lateral fissure approach for hypertensive basal ganglia hemorrhage has the advantages of smaller wound, quick recovery of neurological function and favourable prognosis.