优势侧基底节区脑出血手术入路的选择

Approach to evacuate basal ganglia hematoma in dominant side

目的探讨优势侧基底节区脑出血手术入路的不同对患者语言功能恢复的影响。方法纳入优势侧基底节区(包括累及额叶、颞叶及丘脑)血肿60例患者,根据中国康复研究中心汉语标准失语症检查量表对31例经脑池-侧裂-岛叶入路和29例经颞中回皮层-岛叶入路患者术前、术后1和3个月进行失语症评分检查。结果手术前的各组分值均小于手术后评分,经过治疗后各组语言评分分值均有所提高,术后3个月各组语言评分分值较术后1个月均有提高。经脑池-侧裂-岛叶入路较经颞中回皮层-岛叶入路患者术后1个月(t=3.783,P<0.001)、术后3个月(t=9.365,P<0.001)语言功能都有提高,差异有统计学意义。结论优势侧基底节区脑出血经脑池-侧裂-岛叶入路的微创手术在不破坏颞叶皮层及语言中枢的情况下,可将手术创伤降至最低患者术后语言功能得到最大程度的恢复。

Objective To investigate language function recovery of the different approach to evacuate basal ganglia hematoma in dominant side. Methods A total of 60 patients of basal ganglia hematoma involved in frontal lobe, temporal lobe and thalamus in dominant side were enrolled. The hematoma in 31 cases was evacuated via the transsylvian approach, while in 29 cases via the transtemporal cortex approach. The lan guage function with Chinese Rehabilitation Research Center Standard Aphasia Examination （CRRCAE） before the surgery, 1 month and 3 months after surgery was evaluated. Results A total of 31 patients via transsylvian ap proach and 29 cases via transtemporal cortex approach were enrolled. The total scores and the average scores after the surgery were all increased significantly. The language score was increased gradually in 1st month and 3rd month after surgery. The total scores and the average scores of cases via transsylvian approach were all significantly increased on contrasted with which of the cases via transtemporal cortex approach （ t=3.783 and 9.365, P〈0.001）. Conclusions There are significant advantages evacuating basal ganglia hematoma via the transsylyian approach, which is beneficial for lessening the injury in language cortex and recovery of language function.