外侧裂入路手术对基底节区HICH患者的临床效果及方法分析

Clinical efficiacy and method analysis of operation approach in lateral fissure for patients with HICH in basal ganglia region

目的分析外侧裂入路手术治疗基底节区高血压脑出血(HICH)的临床效果。方法回顾性分析该院神经外科2012-2015年手术治疗的120例基底节区HICH患者临床资料,其中64例患者采用外侧裂-岛叶入路治疗(外侧裂组),56例采用传统经颞叶皮层入路手术治疗(经颞叶组),对比两组围术期指标及效果。结果与经颞叶组比较,外侧裂组手术时间明显缩短,血肿清除率明显升高,差异均有统计学意义(P<0.05);两组术后再出血率、手术并发症发生率比较,差异均无统计学意义(P>0.05);外侧裂组术后第1、3、6个月的日常生活活动能力(ADL)巴氏指数评分明显高于经颞叶组(P<0.05);外侧裂组术后1例患者死亡,经颞叶组2例死亡;外侧裂组的预后良好率为70.31%,明显高于经颞叶组的51.78%(P<0.05)。结论外侧裂入路手术治疗基底节区HICH较经颞叶皮层入路手术时间更短、血肿清除更加彻底,预后效果更好。

Objective To analyze clinical efficacy of operation approach in lateral fissure for patients with hypertensive in- tracerebral hemorrhage （HICH） in basal ganglia region. Methods Retrospectively analyzed 120 cases of patients with HICH in basal ganglia region in the department of neurosurgery in our hospital from 2012 to 2015. Among them, 64 cases of patients were treated by surgery via lateral fissure-insular approach （lateral fissure group）, the other 56 cases of patients were treated by surgery via the traditional trans--temporal cortex approach （temporal lobe group）. The perioperative indicators and clinical efficacy were compared between the two groups. Results Compared with the temporal lobe group,the operative time in the lateral fissure group was decreased, and the hematoma clearance rate was increased, there were statistically significant differences（P〈0.05）. No statisti- cally significant difference was found in postoperative re-bleeding rate and rate of complications between the two groups（P〉0.05）. The activity of daily living （ADL） Barthel index scores, 1 month, 3 months and 6 months after operation,in the lateral fissure group were significantly higher than those in the temporal lobe group（P〈0.05）. In the lateral fissure group one patient died and in the temporal lobe group 2 patients died. The proportion of patients with good prognosis in the lateral fissure group （70. 31%） was higher than that in the the temporal lobe group（51.78% ,P〈0.05）. Conclusion Patients with HICH in basal ganglia region treated by operation via lateral fissure-insular approach undergo a shorter operation time,hematoma is evacuated more thoroughly, and have better postoperative prognosis, compared with those patients treated by operation via traditional trans--temporal cortex approach.