基底节区高血压脑出血CT分型及其对手术选择的影响

CT Classification of Hypertensive Intracerebral Hemorrhage in Basal Ganglia and Its Influence on Surgical Selection

目的探讨基底节区高血压脑出血CT分型,并分析其对手术选择的影响。方法将我院收治的72例基底节区高血压脑出血患者作为研究对象,依照CT影像中出血部位和累及区域将基底节区脑出血进行分型(前部型、后部型、中间型和混合型),根据CT分型选择手术入路,分析手术治疗效果。结果72例患者CT分型显示前部型比例为9.72%(7/72),后部型比例为48.61%(35/72),中间型比例为27.78%(20/72),混合型比例为13.89%(10/72)。所有患者均顺利完成手术,其中38.89%(28/72)经侧裂-岛叶入路,61.11%(44/72)经中央后回下点-岛叶入路。术后1d脑部CT复查显示血肿清除超过90%者67例,血肿清除为75%-90%者5例,平均住院时间(15.93±1.78)d。所有患者术后均随访6个月以上,GOS评分显示恢复良好比例为23.61%,中度残疾比例为50.00%,重度残疾比例为22.22%,植物生存比例为4.17%,无死亡。结论依照CT影像中侧裂前点和血肿主体关系对基底节区高血压脑出血患者进行分型,可指导手术入路选择,有利于血肿清除,改善预后。

Objective To explore the CT classification of hypertensive intracerebral hemorrhage in basal ganglia and analyze its influence on surgical selection.Methods 72 patients with hypertensive intracerebral hemorrhage in basal ganglia in our hospital were selected for the study.The cerebral hemorrhage in basal ganglia was classified according to the hemorrhage site and affected area in CT imaging(anterior,posterior,intermediate and mixed types).The surgical approaches were selected according to the CT classification,and the surgical treatment effects were analyzed.Results CT classification of 72 patients showed the proportions of anterior type,posterior type,intermediate type and mixed type were 9.72%(7/72),48.61%(35/72),27.78%(20/72)and 13.89%(10/72).All patients successfully completed the operation,of which 38.89%(28/72)were in lateral fissureisland lobe approach and 61.11%(44/72)were in postcentral gyrus-insular lobe approach.Brain CT scan at 1d after operation showed there were 67 cases with hematoma clearance more than 90% and 5 cases with hematoma clearance from 75% to 90%,and the average hospital stay was(15.93±1.78)d.All patients were followed up for more than 6 months after operation,and the GOS score showed the good recovery rate of 23.61%,moderate disability ratio of 50.00%,severe disability ratio of 22.22% and plant survival rate of 4.17%,and no death.Conclusion Classification for patients with hypertensive intracerebral hemorrhage in basal ganglia according to the relationship between anterior lateral cleft and main body of hematoma in the CT imaging can guide the choice of surgical approaches,and it is conducive to hematoma clearance and improve prognosis.