小骨窗开颅经侧裂径路显微外科治疗高血压基底节区脑出血的疗效分析

Clinical Analysis of Microsurgical Treatment of hypertensive basal Ganglia Hemorrhage through small Bone Window Craniotomy via lateral Fissure Approach

目的小骨窗开颅经侧裂径路显微外科治疗高血压基底节区脑出血的疗效分析,以便为日后临床制定治疗方案提供参考。方法选取2020年9月至2022年10月新乡市第二人民医院收入的高血压性基底节区脑出血患者68例,依据数字表法随机分为对照组与研究组,各34例,对照组接受传统骨瓣开颅颞中回入路手术治疗,研究组接受小骨窗开颅经外侧裂入路显微手术治疗,观察两组患者围手术期相关状况(包含手术耗时、术后住院时间及血肿清除率、术后意识恢复时间)、意识恢复情况[使用格拉斯哥昏迷量表(GCS)评估]、日常生活能力[应用日常生活能力量表(ADL)进行分析]及并发症风险(包含术后再出血、泌尿系统感染、肺部感染及消化道出血)并进行组间比较。结果研究组患者手术耗时、术后意识恢复时间及住院时间均短于对照组,血肿清除率、术后各时间段GCS及ADL评分均高于对照组,且并发症风险低于对照组,差异有统计学意义(P<0.05)。结论高血压性基底节区脑出血患者应用小骨窗开颅经外侧裂入路显微手术治疗具有积极意义,其可有效提高血肿清除率,缩短手术时间,改善GCS评分和ADL评分,具有安全性。

Objective To analyze the efficacy of microsurgical treatment of hypertensive basal ganglia hemorrhage through small bone window craniotomy via lateral fissure approach,in order to provide reference for future clinical treatment plans.Methods From September 2020 to October 2022,68 patients with hypertensive intracerebral hemorrhage in the basal ganglia region from the Second People's Hospital of Xinxiang City were selected and randomly divided into the control group and the study group according to the number table method,34 patients in each group.The control group received traditional craniotomy through the middle temporal gyrus approach,and the study group received microsurgery through the small bone window craniotomy via the lateral fissure approach,The perioperative related conditions(including operation time,postoperative hospital stay,hematoma clearance rate,and postoperative consciousness recovery time),consciousness recovery(assessed with Glasgow coma scale(GCS)),ability of daily living(ADL),and complication risk(including postoperative rebleeding,urinary system infection,pulmonary infection,and gastrointestinal bleeding)were observed and compared between the two groups.Results the surgery time,postoperative consciousness recovery time,and hospitalization time of the study group were shorter than those of the control group.The hematoma clearance rate,GCS and ADL scores at various postoperative time periods were higher than those of the control group,and the risk of complications was lower than that of the control group,with statistical significance(P<0.05).Conclusion The use of small bone window craniotomy through lateral fissure approach for microsurgical treatment of hypertensive basal ganglia hemorrhage patients has positive significance.It can effectively improve hematoma clearance rate,shorten surgical time,improve GCS score and ADL score,and is safe.