直切口小骨窗经侧裂入路显微手术对高血压基底核区脑出血患者的预后研究

Research on prognosis of hypertensive basal ganglia hemorrhage treated through straight cut transsylvian transinsular approach with microsurgery

目的：探讨直切口小骨窗经侧裂入路显微手术对高血压基底核区脑出血患者的影响。方法：选取高血压基底核区脑出血患者80例,依据CT显示确定其基底核区出血症状,血肿量20-65ml。按随机数表法随机将患者分为对照组和观察组,每组40例。对照组行常规骨瓣开颅手术方法;观察组行直切口小骨窗经侧裂入路显微手术,开颅后两组均切开岛叶皮质清除血肿。观察并统计不同手术措施对高血压基底核区脑出血患者的预后影响。结果：术后血肿清除量,观察组〉90%28例,60%-90%10例,〈60%2例,对照组上述三个等级的例数分别为9、17和14例,两组差异统计学意义（P〈0.05）;预后情况比较,观察组ADL评分Ⅰ-Ⅴ级例数分别为15例、8例、14例、2例和1例,相比对照组各等级例数7例、19例、5例、7例和2例具显著差异（P〈0.05）;治疗前两组生活质量评分不具统计学差异（P〉0.05）,治疗后观察组和对照组生活质量评分分别为86.1±2.1和64.5±2.7,两组比较差异显著（P〈0.05）。结论：使用直切口小骨窗经侧裂入路显微手术能对消除高血压基底核区脑出血患者血肿情况产生积极影响,预后效果较好,患者生活质量明显提高。

Objective：To explore the influences of straight cut transsylvian transinsular approach with microsurgery to patients with hypertensive basal ganglia hemorrhage.Methods：80cases of patients with hypertensive basal ganglia hemorrhage were selected from our hospital hematoma volume 20 - 65 ml.the patients were randomly divided into control group and observation group by a random number table,40 cases each.The control group underwent conventional craniotomy surgical methods;observation group were small bone window cut straight through lateral fissure approach microsurgery,both groups after craniotomy to remove the hematoma cut the insular cortex.Observation and statistical prognostic impact of different surgical measures on hypertensive basal ganglia intracerebral hemorrhage patients.Results：After review of head CT,compare the amount of postoperative hematoma,observation group 90% of the 28 cases,60% to 90% of the 10 cases,60% two cases,while the control group the number of cases of the three grades were 9,17 and 14cases,there was significant difference（P〈0.05）;the postoperative prognosis compared with the observation groupⅠ - Ⅴ grade ADL score the number of cases were 15 cases,8cases,14 cases,2cases and one case,compared to the control group the number of cases of each grade 7cases,19 cases,5cases,seven cases and two cases with significant differences（P〈0.05）;test showed that the two groups before treatment,quality of life scores were not statistically different（P〈0.05）,the observation group and the control group quality of life after treatment scores were 86.1± 2.1and 64.5±2.7,there was significant difference between the two groups（P〈0.05）.Conclusion：Use the straight cut transsylvian transinsular approach with microsurgery can produce basal ganglia eliminate hypertension in patients with cerebral hematoma bleeding positive impact,the prognosis is better,the quality of life of patients significantly improved,worthy of promotion.