显微镜下不同手术入路治疗老年高血压基底节区脑出血患者的临床对比研究

Comparison of the effects of different operation approachs under microscope in treating basal ganglia region cerebral hemorrhage in the elderly patients with hypertension

目的观察显微镜下经侧裂入路与经颞中回入路治疗50例老年高血压基底节区脑出血患者的临床效果。方法 回顾分析川北医学院附属第二医院神经外科2010年6月至2011年6月行显微镜下经侧裂-岛叶入路及颞中回入路治疗老年高血压基底节区脑出血患者50例，分为A组和B组，每组25例；A组采用显微镜下经侧裂入路开颅血肿清除术，B组采用显微镜下经颞中回入路开颅血肿清除术。随访0．5～1年，评价其格拉斯哥预后分级（GOS）。结果 A组患者死亡（GOS分级I级）3例、生存22例，其中植物生存（GOS分级Ⅱ级）3例、重残（GOS分级Ⅲ级）3例、中残（GOS分级Ⅳ级）10例、良好（GOS分级V级）6例；B组患者死亡3例、生存22例，其中植物生存3例、重残6例、中残10例、良好3例；结论 显微镜下经侧裂入路治疗老年高血压基底节区脑出血患者的临床效果可靠，手术创伤小，清除血肿彻底，是治疗老年高血压基底节区脑出血患者首选手术方式。

Objective To compare the clinical effects between lateral fissure of cerebrum region approach and middle temporal gyms approach under microscope in treating basal ganglia region cerebral hemorrhage in 50 elderly patients with hypertension. Methods The clinical data of 50 patients with hypertension suffering from basal ganglia region cerebral hemorrhage who received operation treatment under microscope in the Second Affiliated Hospital of North Sichuan Medical College From June 2010 to June 2011 were collected and analyzed. These patients were divided into group A and group B, with 25 cases in each group. Group A received the operation through lateral fissure of cerebrum region under microscope, and group B received the operation through middle temporal gyrus under microscope. Glasgrow outcome score （GOS） was evaluated after six months to one year. Results After the follow-up of six months to one year, GOS showed 3 cases of grade 1, 3 cases of grade 2, 3 cases of grade 3, 3 cases of grade 4 and 6 cases of grade 5 in group A, compared with 3, 3, 6, 10, 3 cases in group B. Conclusions The operation through lateral fissure of cerebrum region under microscope is reliable and effective in treating basal ganglia region cerebral hemorrhage in the elderly patients with hypertension.