小骨窗经额叶入路治疗高血压基底节区脑出血的临床研究

Clinical study of small window craniotomy frontal approach on treatment of hypertensive basal ganglia hemorrhage

目的探究小骨窗经额叶入路治疗高血压基底节区脑出血的临床效果。方法选取北京航天中心医院2012-01-2016-01行小骨窗经额叶入路显微手术和常规大骨瓣开颅手术治疗的高血压基底节区脑出血患者76例,其中行小骨窗经额叶入路显微手术患者为观察组(n=38),行常规大骨瓣开颅手术患者为对照组(n=38),2组术前一般资料比较无明显差异。观察2组血肿复发、血肿清除率、住院时间及治疗前后昏迷程度,比较2组手术期间及术后相关并发症发生情况,并在术后随访半年,采用格拉斯哥评价量表(GOS)评分评定2组预后情况。结果观察组血肿复发率5.26%明显低于对照组21.05%(P<0.05),血肿清除率(84.59±6.49)%、术后14dGCS评分(10.62±2.10)分显著高于对照组(P<0.05),住院时间(13.95±4.74)d显著较对照组短(P<0.05)。观察组并发症发生率7.89%明显低于对照组26.32%(P<0.05)。观察组预后良好率73.68%明显高于对照组50.00%(P<0.05)。结论相比于常规大骨瓣开颅手术,骨窗经额叶入路显微手术治疗高血压基底节区脑出血效果更好,可明显提高血肿清除率、减少住院时间,并减轻患者昏迷程度,降低血肿复发与并发症发生风险,改善预后。

Objective To investigate the clinical effect of small window craniotomy frontal approach on treatment of hyper-tensive basal ganglia hemorrhage .Methods 76 cases with hypertensive basal ganglia hemorrhage in our hospital from January 2012 to January 2016 underwent small window craniotomy frontal approach microsurgery and routine large craniectomy were di-vided into the observation group （small window craniotomy frontal approach microsurgery ,n=38） and the control group （routine large craniectomy ,n= 38） .Hematoma recurrence ,hematoma clearance rate ,hospital stay ,the severity of coma before and after treatment of the two groups were observed ,related complications during intraoperative and postoperative period were compared , followed up for half a year ,GOS score was used to evaluate the prognosis of the 2 groups .Results Hematoma recurrence rate of the observation group （5.26% ） was significantly lower than that of the control group （21.05% ） （P〈0.05） ,hematoma clearance rate [（84.59 ＆#177; 6.49）% ] ,14d postoperative GCS score [（10.62 ＆#177; 2.10）] of the observation group were significantly higher than those of the control group （P〈0.05） .Hospital stay [（13.95 ＆#177; 4.74）d] was significantly shorter than that of the control group （P〈0.05） .Prognosis good rate of the observation group （73.68% ） was significantly higher than that of the control group （50.00% ）（ P〈0.05） .Conclusion Compared with routine large craniectomy ,small window craniotomy frontal approach micro-surgery has better curative effect on treatment of hypertensive basal ganglia hemorrhage ,it can improve hematoma clearance rate , reduce hospital stay ,relieve the severity of coma ,lower risks of hematoma recurrence and complications ,and improve prognosis of patients .