显微手术经侧裂-岛叶入路对基底节区高血压脑出血患者血肿清除和脑损伤的影响

Effect of microsurgical transsylvian insular approach on hematoma clearance and brain injury in patients with hypertensive intracerebral hemorrhage in basal ganglia

目的探讨显微手术经侧裂-岛叶入路对基底节区高血压脑出血患者血肿清除以及脑损伤的影响。方法回顾性分析2017年4月~2020年7月本院神经外科收治的93例基底节高血压脑出血患者的临床资料,按显微手术入路不同,分为A组(经侧裂-岛叶入路,58例)和B组(经颞叶皮质入路,35例)。比较分析两组血肿清除率、并发症、脑损伤实验室指标[血清S100钙结合蛋白B(S100B)、神经特异性烯醇化酶(NSE)]和近期预后状况。结果A组术后24h血肿清除率>90%者占86.21%,血肿清除率(94.60±3.05)%,均高于B组68.57%、(87.73±6.12)%,差异有统计学意义(P<0.05)。A组术后再出血、肺部感染、消化道出血总发生率27.59%低于B组40.00%,差异有统计学意义(P<0.05)。术前血清S100B、NSE水平与血肿量均呈正相关(r=0.858、0.713,P<0.05),A组术后7d血清S100B、NSE水平低于B组,差异有统计学意义(P<0.05)。两组术后6个月近期预后比较,差异无统计学意义(P>0.05)。结论显微手术经侧裂-岛叶入路治疗基底节区高血压脑出血效果显著,具有血肿清除充分、并发症少和减轻脑损伤的优点。

Objective investigate the effect of microsurgical transsylvian insular approach on hematoma clearance and brain injury in patients with hypertensive intracerebral hemorrhage in basal ganglia.Methods The clinical data of 93 patients with hypertensive intracerebral hemorrhage in basal ganglia treated in neurosurgery department of our hospital from April 2017 to July 2020 were retrospectively analyzed.According to different microsurgical approaches,they were divided into group A(58 cases via lateral fissure insular approach)and group B(35 cases via temporal cortex approach).Hematoma clearance rate,complications,laboratory indexes of brain injury[serum S100 calcium binding protein B(S100 b),neuron specific enolase(NSE)]and short-term prognosis of the two groups were compared and analyzed.Results In group A,the hematoma clearance rate>90%was 86.21%,and the hematoma clearance rate was(94.60±3.05)%,which was higher than 68.57%and(87.73±6.12)%in group B(P<0.05).The total incidence of postoperative rebleeding,pulmonary infection and gastrointestinal bleeding in group A was 27.59%,which was lower than 40.00%in group B(P<0.05).Preoperative serum S100 Band NSE levels were positively correlated with hematoma volume(r=0.858,0.713,P<0.05).Serum S100 Band NSE levels in group A were lower than those in group B 7 days after operation,and the difference was statistically significant(P<0.05).There was no significant difference in the short-term prognosis between the two groups 6 months after operation(P>0.05).Conclusion Microsurgical treatment of hypertensive intracerebral hemorrhage in basal ganglia via transsylvian insular approach is effective,with the advantages of sufficient hematoma clearance,less complications and less brain injury.