扩大翼点入路改良手术治疗基底节区脑出血并脑疝疗效观察

Clinical observation of extended pterional approach in the treatment of basal ganglia hemorrhage with cerebral hernia

目的评估对基底节区高血压脑出血合并脑疝患者应用扩大翼点入路改良方法治疗的临床疗效。方法选取接受传统大骨瓣血肿清除手术治疗的基底节区脑出血并脑疝患者122例为传统组,接受扩大翼点入路改良手术治疗的基底节区脑出血并脑疝患者96例为改良组。术后6个月,采用格拉斯哥预后量表(GOS)比较两组患者的临床疗效,统计两组患者的术后再次出血量、术后ICU住院天数及住院费用。结果改良组的病死率低于传统组,恢复良好或中度残疾率高于传统组(P均<0.05);改良组术后再次出血量、术后ICU住院天数、住院费用少于传统组(P均<0.05)。结论应用扩大翼点入路改良手术治疗基底节区脑出血合并脑疝患者,能降低病死率、有效改善预后、减少术后再次出血量、缩短术后ICU住院天数、降低费用。

Objective To evaluate the clinical efficacy of modified enlarged pterional approach in the treatment of hypertensive basal ganglia cerebral hemorrhage complicated with cerebral hernia.Methods A total of 122 patients with basal ganglia cerebral hemorrhage and hernia treated by traditional large bone flap hematoma removal were selected as the traditional group,and 96 patients with basal ganglia cerebral hemorrhage and hernia treated by modified enlarged pterional approach were selected as the modified group.Six months after surgery,Glasgow Outcome Scale(GOS)was used to compare the clinical efficacy of the two groups,and the amount of postoperative rebleeding,postoperative ICU stay and hospitalization cost of the two groups were counted.Results The mortality rate of the modified group was lower than that of the traditional group,and the rate of good recovery or moderate disability was higher than that of the traditional group(all P<0.05).The amount of postoperative rebleeding,postoperative ICU stay and hospitalization cost in the modified group were less than those in the traditional group(all P<0.05).Conclusion The application of extended pterional approach for patients with basal ganglia cerebral hemorrhage complicated with cerebral hernia can reduce mortality,effectively improve prognosis,reduce the amount of postoperative rebleeding,shorten the length of stay in ICU and reduce the cost.