小骨窗经侧裂-岛叶皮层入路清除基底节区脑出血的临床研究

Clinical study of small bone window via lateral fissure-insular cortex approach to remove cerebral hemorrhage in basal ganglia

目的观察小骨窗经侧裂-岛叶皮层入路直切口或弧形切口手术清除基底节区脑出血的疗效。方法选取2018年3月至2019年7月在廉江市人民医院就诊的50例高血压脑出血患者为研究对象。采用随机数表法分为观察组和对照组,每组25例。对照组患者采取骨瓣开颅皮层入路手术治疗,观察组患者采取经侧裂-岛叶入路小骨窗手术治疗。比较两组患者的手术时间、术中出血量、住院时间和住院费用;比较两组患者治疗结束3个月后的日常生活能力分级情况,以及治疗前及治疗结束3个月后的生活质量评分和并发症发生情况。结果观察组患者的手术时间、住院时间分别为(90.46±12.73) min、(24.58±2.17) d,明显短于对照组的(100.45±12.75) min、(40.69±2.19) d,术中出血量、住院费用分别为(34.58±1.13) m L、(59 462±741)元,明显少于对照组的(46.69±1.18) mL、(67 150±745)元,差异均有统计学意义(P<0.05);治疗结束3个月后,观察组患者日常生活能力分级情况主要集中在1~3级,对照组患者日常生活能力分级情况主要集中在2~4级,观察组患者的日常生活能力分级情况明显优于对照组,差异均有统计学意义(P<0.05);治疗前,两组患者的生活质量评分比较差异均无统计学意义(P>0.05);治疗结束3个月后,观察组患者的心理卫生、躯体功能、健康程度、情绪角色评分分别为(76.25±7.57)分、(73.48±6.23)分、(80.97±5.10)分、(78.31±6.37)分,明显高于对照组的(65.38±7.52)分、(65.79±6.22)分、(74.55±5.09)分、(70.92±6.34)分,差异均有统计学意义(P<0.05);观察组患者的并发症发生率为4.00%,明显低于对照组的24.00%,差异有统计学意义(P<0.05)。结论小骨窗经侧裂-岛叶皮层入路,6~8 cm直切口、弧形切口手术能有效清除基底节区脑出血患者的脑内血肿,减少术中出血量,缩短手术时间,改善患者的日常生活能力及生活质量,降低并发症发生率,减少住院时间,值得临床推广使用。

Objective To observe the curative effect of small bone window surgery via lateral fissure-insular cortex approach in the treatment of hypertensive intracerebral hemorrhage(HICH)in basal ganglia.Methods From March 2018 to July 2019,50 patients with hypertensive cerebral hemorrhage in Lianjiang People's Hospital were selected as the research objects.They were randomly divided into observation group and control group,with 25 patients in each group.The control group was treated with bone flap craniotomy through cortical approach,while the observation group was treated with small bone window surgery via lateral fissure-insular cortex approach.After the treatment,the operation time,intraoperative blood loss,length of hospital stay,and hospitalization expenses of the two groups were compared.The classification of daily living ability of the two groups three months after the end of treatment was compared.The quality of life scores of the two groups before and after treatment were compared.The incidence of complications was calculated.Results The operation time and length of hospital stay in the observation group were(90.46±12.73)min and(24.58±2.17)d,which were significantly shorter than(100.45±12.75)min and(40.69±2.19)d in the control group,and intraoperative blood loss and hospitalization expenses were respectively(34.58±1.13)mL and(59462±741)yuan,which were significantly less than(46.69±1.18)mL and(67150±745)yuan in the control group(P<0.05).Three months after the end of treatment,the grading of daily living ability in the observation group was mainly concentrated in grades 1-3,which was significantly better than grades 2~4 of the control group(P<0.05).Before treatment,there was no statistically significant difference in the quality of life scores between the two groups(P>0.05);three months after the end of treatment,the scores of mental health,physical function,health degree,and emotional role in the observation group were(76.25±7.57)points,(73.48±6.23)points,(80.97±5.10)points,(78.31±6.37)points,respectively,which were significantly higher than(65.38±7.52)points,(65.79±6.22)points,(74.55±5.09)points,(70.92±6.34)points in the control group(P<0.05).The complication rate in the observation group was 4.00%,which was significantly lower than 24.00%in the control group(P<0.05).Conclusion Small bone window surgery through lateral fissure-island cortex approach(6-8 cm straight incision,curved incision)can effectively remove the cerebral hematoma in patients with HICH in basal ganglia,reduce intraoperative blood loss,shorten operative time,improve the ability of daily life and quality of life of patients,reduce the incidence of complications,the cost of hospitalization,and the length of hospital stay,which is worthy of clinical promotion.