不同手术方式对基底核区脑出血患者的疗效差异及免疫功能的影响

Effect of different surgical procedues on therapeutic effectiveness and immunologic function in basal ganglia hemorrhage patients

目的 探讨超早期经脑回皮质手术与经脑沟裂入路显微手术对基底核区脑出血患者的疗效差异及免疫功能的影响。方法 回顾性分析新乡医学院第一附属医院于2018年1月~2020年1月收治的128例行超早期经脑回皮质手术(经脑回皮质组)和135例行经脑沟裂入路显微手术(经脑沟裂入路组)的基底核区脑出血患者临床资料。比较2组患者的疗效、手术并发症及手术前后免疫功能指标变化情况。结果 经脑沟裂入路组的临床治疗有效率显著高于经脑回皮质组(85.19%vs 64.06%,P=0.000);经脑沟裂入路组术后4周、12周时Barthel指数量表评分≥35分者显著高于经脑回皮质组[(52.47±6.62)%vs(45.26±6.58)%,(68.95±8.95)%vs(62.28±8.64)%,P<0.01]。经脑沟裂入路组术后6个月恢复良好比例显著高于经脑回皮质组(74.07%vs 46.09%,P<0.01);经脑沟裂入路组术后再出血、颅内感染、肺部感染以及气管切开发生率显著低于经脑回皮质组(P<0.05,P<0.01)。与经脑回皮质组同时间点比较,经脑沟裂入路组患者术后1 d、7 d的CD3、CD4细胞阳性率以及CD4/CD8比值显著升高,差异均有统计学意义(P<0.01)。结论 经脑沟裂自然间隙入路显微手术治疗基底核区高血压脑出血临床效果优于经脑回皮质手术,其可明显改善患者免疫紊乱状态。

Objective To study the effect of ultraearly transgyrus cortical surgery and transsulcus fissure approach microsurgery on therapeutic effectiveness and immunologic function in basal ganglia hemorrhage patients.Methods One hundred and twenty-eight basal ganglia hemorrhage patients who underwent ultraearly transgyrus cortical surgery and 135 basal ganglia hemorrhage patients who underwent transsulcus fissure approach microsurgery in our hospital from January 2018 to January 2020 served as transgyrus cortical surgery group and transsulcus fissure approach microsurgery group respectively.Their clinical data were retrospectively analyzed.The clinical therapeutic effectiveness, surgical complications and immunologic function were compared between the two groups before and after surgery.Results The therapeutic effectiveness was significantly better in transgyrus cortical surgery group than in transsulcus fissure approach microsurgery group(85.19% vs 64.06%,P=0.000).The ratio of Barthel index scale score ≥35 was significantly higher in transsulcus fissure approach microsurgery group than in transgyrus cortical surgery group at weeks 4 and 12 after surgery(52.47%±6.62% vs 45.26%±6.58%,68.95%±8.95% vs 62.28%±8.64%,P<0.01).The good recovery rate was significantly higher in transsulcus fissure approach microsurgery group than in transgyrus cortical surgery group at week 6 after surgery(74.07% vs 46.09%,P<0.01).The incidence of rebleeding, intracranial infection, lung infection and the ratio of tracheotomy were significantly lower in transsulcus fissure approach microsurgery group than in transgyrus cortical surgery group(P<0.05,P<0.01).The positive rate of CD3+ cells, CD4+cells and the CD4+cell to CD8+cell ratio were significantly higher in transgyrus cortical surgery group than in transsulcus fissure approach microsurgery group on days 1 and 7 after surgery(P<0.01).Conclusion The therapeutic effectiveness of transsulcus fissure approach microsurgery is higher than that of transgyrus cortical surgery in basal ganglia hemorrhage patients and can significantly improve their immunologic function.