经外侧裂-岛叶入路清除基底节出血的临床效果分析

Analysis of Clinical Effect of Transbasal Fissure-island Approach to Basal Ganglia Bleeding

目的探讨经外侧裂-岛叶清除基底节出血的临床效果。方法选择2015年2月—2018年3月该院收治的高血压所致基底节出血患者80例,随机分为两组,每组40例,观察组选择外侧裂-岛叶入路,对照组采用颞叶上回入路,比较治疗过程中NIHSS评分,两组手术时间、术中清除血肿比例及术后再出血、术后失语发生情况。结果治疗后1周、1月和6月,观察组NIHSS评分分别为(23.5±3.6)分,(21.1±2.8)分和(17.6±2.1)分,均显著低于对照组的(30.8±4.1)分(29.5±3.6)分和(27.8±3.0)分,差异有统计学意义(t=8.462,11.649,17.616,P<0.05),治疗后1周开始,观察组NIHSS评分显著低于治疗前,差异有统计学意义(P<0.05),观察组手术时间为(125.6±28.5)min短于对照组的(156.3±38.8)min(P<0.05),术中清除血肿率为(85.9±11.3)%,高于对照组的(69.8±10.7)%,差异有统计学意义(t=4.033,6.543,P<0.05),观察组术后再出血及失语比例分别为1(2.5%)和2(5.0%)低于对照组的9(22.5%)和10(25.0%),差异有统计学意义(P<0.05)。结论经外侧裂-岛叶入路手术治疗高血压所致基底节出血,能充分清除血肿,术中暴露简单,视野清晰,可有效减少术后再出血与失语比例。

Objective To explore the clinical effect of removing basal ganglia hemorrhage via lateral fissure-island leaf.Methods A total of 80 patients with basal ganglia hemorrhage due to hypertension admitted in our hospital from February 2015 to March 2018 were randomly divided into two groups,40 cases in each group.The observation group chose the lateral fissure-island approach,the upper temporal lobe approach was used in the control group.The NIHSS score during the treatment was compared.The operation time,the percentage of hematoma removed during the operation,the postoperative rebleeding,and the postoperative aphasia in the two groups were compared.Results The NIHSS scores of the observation group were(23.5±3.6)points,(21.1±2.8)points and(17.6±2.1)points,which were significantly lower than those of the control group(30.8±4.1)points,(29.5±3.6)points and(27.8±3.0)points,the difference was statistically significant(t=8.462,11.649,17.616,P<0.05),starting 1 week after treatment,the NIHSS score of the observation group was significantly lower than before treatment,the difference was statistically significant(P<0.05),the operation time of the observation group was(125.6±28.5)min shorter than that of the control group(156.3±38.8)min,the difference was statistically significant(P<0.05),the intraoperative hematoma clearance rate was(85.9±11.3)%,higher than that of the control group(69.8±10.7)%,the difference was statistically significant(t=4.033,6.543,P<0.05),the proportion of postoperative rebleeding and aphasia in the observation group was 1(2.5%)and 2(5.0%)respectively,which was lower than that of the control group 9(22.5%)and 10(25.0)%,the difference was statistically significant(P<0.05).Conclusion Translateral fissure-island approach for the treatment of basal ganglia hemorrhage caused by hypertension can fully remove the hematoma.The intraoperative exposure is simple and the vision is clear,which can effectively reduce the proportion of postoperative rebleeding and aphasia.