超早期骨瓣开颅经侧裂-岛叶显微手术治疗基底节区高血压脑出血的效果

Ultra-early bone flap craniotomy and lateral fissure-island microsurgery for hypertensive cerebral hemorrhage in basal ganglia

目的分析超早期骨瓣开颅经侧裂-岛叶显微手术治疗基底节区高血压脑出血的效果。方法选取本院2016年7月至2020年5月收治的基底节区高血压脑出血需手术治疗的患者46例作为研究对象,根据患者及家属的意愿分为对照组和观察组,各23例。对照组采用经皮层造瘘清除血肿治疗,观察组采用超早期骨瓣开颅(脑出血发生6 h内)经侧裂-岛叶显微手术治疗。比较两组治疗效果、手术操作相关指标及效益指标。结果观察组术后血肿清除率、术后7 d GCS评分、术后6个月日常生活能力(ADL)评分均高于对照组(P<0.05),术后再出血率、术后并发症发生率均低于对照组(P<0.05),且手术时间、住院时间均短于对照组,术中出血量、住院费用均少于对照组(P<0.05)。结论与传统经皮层造瘘血肿清除手术相比,采取超早期骨瓣开颅经侧裂-岛叶显微手术治疗基底节区高血压脑出血,能显著提升血肿清除率,减少正常脑组织损害,缩短患者住院时间,减少住院费用,有利于改善患者生活质量,降低致残可能性。

Objective To analyze the effect of ultra-early bone flap craniotomy and lateral fissure-island microsurgery for hypertensive cerebral hemorrhage in basal ganglia. Methods 46 patients with hypertensive cerebral hemorrhage in the basal ganglia who were treated in our hospital from July 2016 to May 2020 were selected as the study subjects. They were divided into control group and observation according to the wishes of patients and their families, with 23 cases in each group.The control group was treated with percutaneous fistula clearing hematoma, and the observation group was treated with Ultra-early bone flap craniotomy(within 6 h of cerebral hemorrhage) by lateral fissure-island microsurgery. The treatment effect,surgical operation related indexes and benefit indexes were compared between two groups. Results The clearance rate of postoperative hematoma,GCS score at 7 d after operation, and activities of daily living(ADL) score at 6 months after operation in the observation group were all higher than those in the control group(P<0.05), and the postoperative rebleeding rate and the incidence of postoperative complications were lower than those in the control group(P<0.05), and the operation time, hospitalization time were shorter than thosein the control group, intraoperative blood loss, and hospitalization costs were less than in those the control group(P<0.05). Conclusion Ultra-early bone flap craniotomy and lateral fissure-island microsurgery for the treatment of hypertensive cerebral hemorrhage in the basal ganglia area can significantly improve the clearance rate of hematoma,reduce the damage of normal brain tissue and shorten. The length of hospitalization and the reduction of hospitalization costs are conducive to improving the patient’ s quality of life and reducing the possibility of disability.