中央沟下点侧裂入路与颞叶皮层入路治疗高血压脑出血的比较分析

Comparison between translower-rolandicpoint and transtemporal-cortex approaches for evacua-tion in hypertensive intracerebral hemorrhage

目的：比较经中央沟下点侧裂入路与颞叶皮层入路在治疗高血压基底节后部血肿的疗效差异。方法回顾性分析我院自2012-01-2014-12因高血压脑出血基底节区后部血肿急诊行开颅手术64例的临床资料，其中中央沟下点侧裂入路手术（TR组）31例，颞叶皮层入路手术（TC组）33例。比较两组手术情况、术后并发症及术后1个月格拉斯哥预后评分（Glasgow outcome scale, GOS）及术后6个月日常生活恢复情况（activities daily living，ADL）。结果 TC组术后血肿清除率低于TR组，TC组术后48 h及72 h脑组织水肿情况高于TR组，TC组癫痫、视野缺损及失语发生高于TR组（P均＜0.05），TC组术后6个月恢复良好人数少于TR组（P均＜0.05）。结论中央沟下点侧裂入路可降低术后患者癫痫、失语、视野缺损发生率，提高患者远期生存质量，具有良好的安全性和稳定性，是治疗该疾病的一种较好的手术方法。

Objective To compare the efficacy between translower-rolandicpoint （TR） and transtemporal cortex（TC）approach for hypertensive intracerebral hemorrhage（HICH）of posterior type of basal ganglia. Methods We retrospectively analyzed 64 craniotomy cases for evacuation in the posterior type of basal ganglia hematoma of HICH from January 2012 to December 2014. They were divide into two group of different approaches：33 with TC and 31 with TR. We compared the situation among operating, complications and the prognosis which accorded to Glasgow Outcome score（GOS）in one month and Activities Daily Living（ADL）grading in six months. Results TC group had a lower hematoma clearance ratio than TR group. The number of cerebral edema occurred in the patients of TC group was higher than that in TR group 48 h and 72 h after surgery. TC group showed a higher ratio of epilepsy, visual field defect and aphasia than TR group. The differences were statistically significant（P〈0.05）. According to ADL grading, TR group got a better rehabilitation than TC group in 6 months. The difference was statistically significant （P〈0.05）. Two groups showed quite close mortality. Conclusion Using the translower-rolandicpoint approach for posterior type of basal ganglia hematoma will decrease the incidences of epilepsy, aphasia and vision deficiency. It can improve the postoperative living quality after stoke.