经侧裂小骨窗手术治疗基底节区高血压脑出血

Minimally Invasive Surgery for Hypertensive Intracerebral Hemorrhage in Basal Ganglia Area with Transsylvian Fissure-insular Approach

目的探究经侧裂小骨窗手术治疗基底节区高血压脑出血的疗效。方法2016年6月至2019年6月我院神经外科采用经侧裂小骨窗手术基底节区高血压脑出血患者81例(侧裂组),失访10例;采用传统开颅血肿清除手术治疗103例(传统组),失访21例,回顾性比较两组获得随访的患者的临床效果。结果两组患者术后血肿清除率比较无显著差异(χ^2=1.830,P=0.400);侧裂组术后1月GOS分级明显优于传统组(χ^2=12.553,P=0.000);术后30 d死亡结局比较存在显著差异,侧裂组患者有更高的生存获益(χ^2=4.024,P=0.045);侧裂组患者术后6月ADL评分优于传统组(χ^2=5.914,P=0.015)。结论经侧裂小骨窗手术对于基底节区高血压脑出血的血肿清除效果与开放手术相当,但术后功能恢复、日常生活能力和生存获益更好。

Objective To explore the therapeutic effect of minimally invasive surgery for hypertensive intracerebral hemorrhage in basal ganglia area with transsylvian fissure-insular approach.Methods From June 2016 to June 2019,there were 81 patients with hypertensive intracerebral hemorrhage in basal ganglia operated by minimally invasive surgery with transsylvian fissure-insular approach in Department of Neurosurgery in our hospital(group A,with 10 patients lost in follow-up);while 103 patients were treated by traditional craniotomy,and 21 patients were lost in follow-up(group B).The clinical effect of the two groups was compared retrospectively.Results There was no significant difference in the clearance rate of hematoma between the two groups(χ^2=1.830,P=0.400).The GOS grade of group A was significantly better than that of group B(χ^2=12.553,P=0.000)one month after operation.The 30-day mortality rate was 5.6%in group A,which was lower than 15.9%of group B(χ^2=4.024,P=0.045).The ADL score of the patients in group A was better than that of group B(χ^2=5.914,P=0.015).Conclusion The hematoma clearance effect is similar to the open operation of the operation through minimally invasive surgery with transsylvian fissure-insular approach for hypertensive cerebral hemorrhage in the basal ganglia area,but the postoperative functional recovery,daily life ability and survival benefit are better.