经外侧裂-岛叶入路与经颞叶皮质入路治疗基底节区高血压性脑出血的临床对照研究

Clinical Study of Lateral Fissure-insula Approach and Temporal Cortex Approach in the Treatment of Patients with Hypertensive Intracerebral Hemorrhage in Basal Ganglia

目的探讨经外侧裂-岛叶入路与经颞叶皮质入路治疗基底节区高血压性脑出血的临床效果。方法选取2017年1月—2020年12月在内江市第二人民医院接受治疗的基底节区高血压性脑出血病人115例作为研究对象,按照术式不同分为A组(56例)和B组(59例),A组采用经外侧裂-岛叶入路治疗,B组采用经颞叶皮质入路治疗。比较两组病人围术期指标、血肿清除率、再出血率、神经递质水平、死亡率、偏瘫侧肌力和失语好转情况,术后6个月,采用格拉斯哥预后量表(GOS)评估病人预后。结果A组手术时间、住院时间较B组缩短,去骨瓣率明显低于B组,差异均有统计学意义(P<0.05)。两组血肿清除率、再出血率比较差异无统计学意义(P>0.05)。术后A组5-羟色胺(5-HT)、多巴胺(DA)、去甲肾上腺素(NE)水平明显低于B组,差异均有统计学意义(P<0.05);两组6个月内死亡率比较差异无统计学意义(P>0.05),A组6个月内偏瘫侧肌力好转率、失语好转率高于B组(P<0.05);术后6个月随访,A组GOS评分优良率高于B组(P<0.05)。结论与经颞叶皮质入路相比,经外侧裂-岛叶入路治疗基底节区高血压性脑出血病人手术时间更短,术后恢复更快,预后更好。

Objective To explore the clinical effects of lateral fissure-insula approach and temporal cortex approach in the treatment of patients with hypertensive intracerebral hemorrhage(HICH)in basal ganglia.Methods A total of 115 patients with HICH in basal ganglia were selected and divided into group A(56 cases)and group B(59 cases)according to different operation methods.The patients in group A were treated by lateral fissure-insula approach,while the patients in group B were treated by temporal cortex approach.The perioperative indexes,hematoma clearance rate,rebleeding rate,neurotransmitter level,mortality,improvement of muscle strength on the hemiplegic side and aphasia were compared between two groups.At 6 months after surgery,prognosis of patients was evaluated by Glasgow Outcome Scale(GOS).Results The operation time,hospitalization time,and craniectomy rate in group A were significantly lower than those in group B(P<0.05).There was no significant difference between two groups in hematoma clearance rate and rebleeding rate(P>0.05).At 6 mouths after surgery,The levels of 5-hydroxytryptamine(5-HT),dopamine(DA),and norepinephrine(NE)in group A were significantly lower than those in group B(P<0.05).There was no significant difference in mortality between the two groups within 6 months(P>0.05).The improvement rates of muscle strength on the hemiplegic side and aphasia in group A at 6 months were higher than those in group B(P<0.05).The excellent rate of GOS score in group A was higher than that in group B at 6 months follow-up(P<0.05).Conclusion Compared with transtemporal cortex approach,lateral fissure insula approach in the treatment of HICH in basal ganglia is a useful method with shorter operation time,faster postoperative recovery,and better prognosis.