经侧裂-岛叶入路早期显微手术治疗高血压基底节区脑出血的效果

Early microsurgery via transsylvian-transinsular approach in hypertensive intracerebral hematomas in the basal ganglia

目的 比较经侧裂-岛叶入路手术与皮质造瘘入路手术治疗高血压基底节区脑出血的临床效果. 方法 选取2013年1月至2016年12月益阳市中心医院神经外科收治的122例高血压基底节区脑出血患者,按照手术入路方法分为皮质造瘘入路组和侧裂岛叶入路组. 对皮质造瘘入路组的患者采用患侧颞中回皮层造瘘达血肿腔;对侧裂岛叶入路组的患者采用患侧侧裂上端经岛叶皮层达血肿腔. 术后患者复查颅脑CT判断血肿的清除率,比较两组患者入住NICU的时间及日常生活能力（ADL）. 评分情况. 结果 两组患者术后血肿清除率、入住NICU时间及ADL评分比较,差异有统计学意义（P〈0.05）.结论 与皮质造瘘入路相比,侧裂-岛叶入路血肿清除率更高、入住NICU时间更短、预后更好,具有良好的推广价值.

Objective To investigate the clinical value of early microsurgery of hypertensive in-tracerebral hematomas in the basal ganglia via transsylvian-transinsular and cortical fistula approach.Meth-ods A retrospective study was performed on 122 cases of patients with hypertensive intracerebral hemato-mas in the basal ganglia who were admitted from January 2013 to December 2016.According to different surgical approaches,the patients were divided into the cortical fistula approach（CFA） group and the trans-sylvian-transinsular approach（TTA） group.In the CFA group,the ipsilateral left middle temporal gyrus was used as the hematoma cavity;in the TTA group,the ipsilateral lateral fissure and the upper lobe of the insu-lar cortex reached the hematoma cavity.After the operation,the patients were examined by brain CT to de-termine the clearance rate of the hematoma,and the NICU admission time and the daily living ability score were compared between the two groups.Results The differences of postoperative hematoma clearance rate, NICU admission time and ADL between the two groups were statistically significant （P＆lt;0.05）.Conclu-sion Compared with the cortical fistula approach,the transsylvian-transinsular approach has higher hema-toma clearance rate,shorter NICU admission time and better prognosis,which is worth of clinical promotion.