外侧裂岛叶入路与颞叶皮质入路血肿清除术治疗高血压脑出血患者的效果比较

Comparison of effects of hematoma removal through lateral fissure insular approach and temporal lobe cortex approach in treatment of patients with hypertensive cerebral hemorrhage

目的:比较外侧裂岛叶入路与颞叶皮质入路血肿清除术治疗高血压脑出血(HIH)患者的效果。方法:回顾性分析2017年1月至2020年7月88例HIH患者的临床资料,按手术入路方式不同分成观察组(n=44)和对照组(n=44)。对照组接受经颞叶皮质入路血肿清除术治疗,观察组接受外侧裂岛叶入路血肿清除术治疗,比较两组术后3个月治疗优良率、围术期指标水平、手术前后血清中枢神经特异性蛋白(S100-β)和神经元特异性烯醇化酶(NSE)水平及术后1个月并发症发生率。结果:术后3个月,观察组治疗优良率为68.18%(30/44),高于对照组的45.45%(20/44),差异有统计学意义(P<0.05);观察组血肿清除率高于对照组,差异有统计学意义(P<0.05);两组手术时间、术中出血量和引流管放置时间比较,差异均无统计学意义(P>0.05);术后,观察组S100-β蛋白和NSE水平均低于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为2.27%(1/44),低于对照组的18.18%(8/44),差异有统计学意义(P<0.05)。结论:经外侧裂岛叶入路血肿清除术治疗HIH患者可提高治疗优良率和血肿清除率,降低S100-β蛋白水平、NSE水平和并发症发生率,效果优于经颞叶皮质入路血肿清除术治疗。

Objective:To compare effects of hematoma removal through lateral fissure insular approach and temporal lobe cortex approach in treatment of patients with hypertensive cerebral hemorrhage(HIH).Methods:The clinical data of 88 HIH patients from January 2017 to July 2020 were retrospectively analyzed.According to different surgical approaches,they were divided into observation group(n=44)and control group(n=44).The control group received hematoma removal through the temporal lobe cortex approach,while the observation group was given hematoma removal through the lateral fissure insular approach.The excellent and good rate of treatment 3 months after the surgery,the perioperative index levels,the serum central nerve specific protein(S100-β)and neuron-specific enolase(NSE)levels before and after the surgery and the complication rate 1 month after the surgery were compared between the two groups.Results:3 months after the surgery,the excellent and good rate of treatment in the observation group was 68.18%(30/44),which was higher than 45.45%(20/44)in the control group,and the difference was statistically significant(P<0.05).The hematoma removal rate of the observation group was higher than that of the control group,and the difference was statistically significant(P<0.05).There were no significant differences in the operation time,the intraoperative blood loss and the drainage tube placement time between the two groups(P>0.05).After the surgery,the levels of S100-βprotein and NSE in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).Further,the incidence of complications in the observation group was 2.27%(1/44),which was lower than 18.18%(8/44)in the control group,and the difference was statistically significant(P<0.05).Conclusions:Hematoma removal through lateral fissure insular approach can improve the excellent and good rate of treatment and the hematoma removal rate,and reduce the S100-βprotein level,the NSE level and the incidence of complications.Moreover,it is superior to hematoma removal through temporal lobe cortex approach.