锁孔入路与传统开颅治疗基底节区高血压脑出血术后癫痫的对照研究

Control study on keyhole approach and traditional craniotomy in the treatment of basal ganglia region hemorrhage postoperative seizure

目的比较锁孔入路和传统开颅治疗基底节区高血压脑出血术后癫痫的疗效。方法收集2006年9月-2015年3月四川石油管理局总医院神经外科收治的基底节区高血压脑出血患者108例,随机分为两组:锁孔入路治疗组(58例)和传统手术组(50例)。两组患者围手术期均采用相同的管理方案,统计分析两组患者的年龄、性别、出血量、术后癫痫发生率、药物疗效及药物不良反应发生率等。结果两组患者术后随访2年,锁孔入路治疗组术后癫痫发作12例,1例发生癫痫持续状态,无死亡发生;有10例对单一抗癫痫药物(AED)治疗有效,7例出现药物不良反应。传统手术组术后癫痫发作22例,9例发生癫痫持续状态,并有5例因此死亡;仅5例对单一AED治疗有效,15例出现药物不良反应。分析显示两组患者术后癫痫的发生率、重症癫痫发生率、预后、单一AED控制率及药物不良反应等方面有统计学意义(P<0.05)。结论与传统开颅血肿清除术比较,锁孔入路极大减少基底节区高血压脑出血术后癫痫、重症癫痫及药物并发症的发生。锁孔入路治疗基底节区高血压脑出血是一种值得推崇的手术方式。

Objective To compare the keyhole approach and traditional craniotomy in the treatment of basal ganglia region hypertension cerebral hemorrhage postoperative epileptic curative effect comparison keyhole approach and traditional craniotomy in the treatment of basal ganglia region the curative effect of hypertensive cerebral hemorrhage postoperative epilepsy. Methods Collected cases of basal ganglia region admitted in department of neurosurgery our hospital from September 2006 to March 2015,108 cases of hypertensive cerebral hemorrhage patients,randomly divided into two groups: keyhole approach group( 58cases) and conventional surgery group( 50 cases). Two groups of patients with perioperative all use the same management scheme,using statistical methods to analyze clinical data of two groups of patients,such as age,sex,blood loss,postoperative epilepsy,drug efficacy and the incidence of adverse drug reactions,etc. Results Postoperative follow-up of 2 years,keyhole approach group 12 cases sufferred postoperative seizure,1 case of patients with status epilepticus,no death occurred; a total of 10 cases of mono-antiepileptic drug( AEDs)therapy effectively,and 7 cases present adverse drug reactions; Traditional surgical postoperative seizures 22 cases,9 cases occurred status epilepticus,and five died as a result,only five were effective for single therapy,and 15 cases with adverse drug reactions. Statistical results suggest the incidence of postoperative epilepsy,the incidence of severe epilepsy,prognosis,single drug control and adverse drug reactions between the tuo groups have significant difference( P < 0. 05). Conclusion Compared with traditional craniotomy for removal of hematoma,keyhole approach greatly reduce the incidnce of basal ganglia region hypertension cerebral hemorrhage postoperative complications,severe epilepsy and adverse reaction of AEDs. Therefore,keyhole approach in the treatment of basal ganglia region hypertension cerebral hemorrhage is an admirable way of treatment.