早期开颅显微手术治疗高血压基底节区脑出血106例临床研究

Early Craniotomy Microsurgery for Hypertensive Basal Ganglia Hemorrhage: A Clinical Study of 106 Cases

目的探讨早期开颅经侧裂-岛叶入路或经颞叶皮层上中回入路显微手术治疗高血压基底节区脑出血的手术要点及疗效。方法回顾分析2010年1月至2016年6月106例经CT证实血肿量为30m L以上的高血压基底节区出血患者,早期行开颅手术经侧裂-岛叶入路或经颞叶皮层上中回入路显微镜下清除脑出血血肿手术的临床资料。结果本组患者术后第1d行头颅CT复查,血肿清除量90%以上者76例(71.7%),70%~90%者21例(19.8%)。住院期间死亡11例,死亡率10.4%。存活的95例患者随访6个月日常生活能力(ADL)Ⅰ级(完全恢复)7例,Ⅱ级(部分恢复或可独立生活)29例,Ⅲ级(需人帮助,扶拐可行)41例,Ⅳ级(卧床,但保持意识)13例,Ⅴ级(植物生存)5例。结论早期开颅经侧裂-岛叶入路或经颞叶皮层上中回入路显微手术治疗高血压基底节区出血创伤小、手术显露满意、清除血肿较彻底、能有效降低颅内压,是基底节区高血压脑出血的两种有效手术治疗方式。

Objective To explore the key points and curative effect of early craniotomy microsurgery via basisylvian fis- sure-insular approach or superior and middle temporal gyrus approach in the treatment of hypertensive basal ganglia hemorrhage.Methods Clinical data of 106 hypertensive basal ganglia hemorrhage patients with hematoma more than 30ml verified by CT,who underwent early craniotomy microsurgery of hematoma evacuation via basisylvian fissure-insular approach or superior and middie tem- poral gyrus approach during January 2010 to June 2016 ,were retrospectively analyzed. Results As was shown by cerebral CT reex- amination the first day after operation, there were 76 cases（71.7% ）whose hematoma clearance rates were more than 90% and 21 ca- ses（ 19. 8% ）whose hematoma clearance rates were between 70% and 90%. There were 11 patients died during their hospitalization and the mortality was 10.4%. Among the 95 survivors, during their 6-months follow-up, there were 7 cases of grade I （full recovery） activity of daily living（ADL） ,29 cases of grade II （ partial recovery or ability of independent living） ADL ,41 cases of grade III （ neces- sity of help from others or walking with a stick）ADL, 13 cases of grade lV （in bed with full consciousness）ADL and 5 cases of grade V （vegetative survival）ADL. Conclusion Early craniotomy microsurgery via basisylvian fissure-insular approach or superior and mid- die temporal gyrus approach in the treatment of hypertensive basal ganglia hemorrhage, has advantages of minimal trauma, satisfaction of surgical exposure, thorough clearance of hematoma and effective reduction of intraeranial pressure, which are two effective operation of hypertensive basal ganglia hemorrhage.