经侧裂-岛叶入路显微手术对基底节区高血压脑出血的疗效分析

Microsurgical operation through lateral flssure-insula lobe approach in treatment of hypertensive cerebral hemorrhage in basal ganglia

目的探讨经侧裂-岛叶人路显微手术对基底节区高血压脑出血的疗效。方法回顾性分析2010年1月-2013年6月64例基底节高血压脑出血患者临床资料。其中41例行经侧裂-岛叶入路显微手术(A组);另23例行常规骨瓣开颅手术(B组),比较2组治疗效果及近远期预后。结果 A组手术时间(115.35±46.23)min、术后自动睁眼时间(5.22±3.43)h均短于B组(212.43±58.24)min、(8.74±4.51)h(P<0.05)。术后7 d A组GCS评分(11.92±2.73)分高于B组(9.85±2.46)分(P<0.05)。术后48 h行CT复查,A组血肿大部分清除率为80.49%(33/41)优于B组的56.52%(13/23)(P<0.05)。观察组与对照组并发症发生率无明显差异(39.02%vs.47.83%,P>0.05)。术后3个月随访,A组优良率为60.98%(25/41),明显高于B组的34.78%(8/23)(P<0.05)。术后12个月随访,A组优良率为72.50%(29/40),明显高于B组的47.62%(10/21)(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 investigate the curative effect of the transsylvian insular approach, microsurgieal operation on hypertensive cerebral hemorrhage in basal ganglion. Methods From 2010 January to 2013 June, a retrospective analysis the clinical data of 64 cases hypertensive cerebral hemorrhage were performed. Among them, 41 cases underwent lateral fissure and insula microsurgical operation （ group A） ; the other 23 underwent conventional craniotomy operation （ group B ）, compare the therapeutic effect of 2 groups and the short - and long-term prognosis. Results The operation time of group A was （115.35±46.23 ） rain, automatic opening eye time after operation was （5.22±3.43） h, which were all shorter than in the B group＇ s （212.43± 58.24） rain, and （8.74±4.51 ） h （ P 〈 0.05）. After 7 d, group A＇ s GCS score was （ 11.92±2.73 ） points, which is higher than that in group B with （9.85±2.46） points （ P 〈 0.05 ）. After 48 h＇ s CT examination revealed that, group A＇ s most hematoma clearance rate was 80.49% （33/41） , which is better than that of B group＇ s 56.52% （ 13/23 ） （ P 〈 0.05 ）. The observation group had no significant difference with the control group in the incidence of complications （39.02% vs. 47.83%, P 〉 0.05）. Followed up after operation for 3 months, in group A, the excellent and good rate was 60.98% （25/41） , significantly higher than that of group B＇ s 34.78% （8/23） （ P 〈 0.05）. Followed up for 12 months after operation, in group A, the excellent and good rate was 72.50% （29/40） , significantly higher than that of group B＇ s 47.62% （ 10/21 ） （ P 〈 0.05 ）. Conclusion Through lateral fissure and insula microsurgieal operation for treatment of brain hemorrhage is less injury, good efficacy and less complications.