超早期经脑沟裂入路与经脑回皮质入路显微手术治疗基底节区脑出血的疗效分析

Therapeutic effects of ultra-early microsurgery through the cerebral sulcus fissure vs the cerebral gyrus cortex approach for the treatment of basal ganglia hemorrhage

目的比较超早期经脑沟裂入路与经脑回皮质入路显微手术治疗基底节区脑出血的疗效。方法选择西安医学院第二附属医院神经外科自2021年1月至2022年12月收治的122例基底节区脑出血患者进行回顾性分析。所有患者均在发病后7 h进行手术,并根据手术方法分为2组,其中脑沟裂入路组68例,脑回皮质入路组54例。比较2组患者的手术相关指标、并发症发生率,术前、术后7 d血清NE和5-HT水平,术前、术后30 d美国国立卫生研究院卒中量表(NIHSS)、斯堪的纳维亚卒中量表(SSS)评分,以及术后30 d预后情况。结果2组患者手术时间、血肿清除率、术中出血量、住院时间及再出血发生率比较,差异均无统计学意义(P>0.05)。术后7 d,2组患者血清5-HT、NE水平较术前明显升高,且脑沟裂入路组高于脑回皮质入路组,差异均有统计学意义(P<0.05)。术后30 d,2组患者NIHSS评分较术前明显降低,SSS评分较术前明显升高,且脑沟裂入路组NIHSS评分低于脑回皮质入路组,SSS评分高于脑回皮质入路组,差异均有统计学意义(P<0.05)。脑沟裂入路组的预后良好率(94.12%)高于脑回皮质入路组(66.66%),差异有统计学意义(P<0.05)。结论超早期经脑沟裂入路显微手术治疗基底节区脑出血的疗效优于经脑回皮质入路显微手术,可减轻对5-HT、NE的抑制,有助于神经功能的恢复。

Objective To compare the therapeutic effects between ultra-early microsurgery through the cerebral sulcus fissure and the cerebral gyrus cortex approach for the treatment of basal ganglia hemorrhage.Methods A retrospective analysis was conducted on 122 patients with basal ganglia hemorrhage treated at Neurosurgery Department of the Second Affiliated Hospital of Xi'an Medical University from January 2021 to December 2022.All patients underwent surgery within 7 h after the onset of symptoms and were divided into two groups based on the surgical approach:68 cases in the cerebral sulcus fissure group and 54 cases in the cerebral gyrus cortex group.The study compared the surgical-related indicators,complication rates,serum 5-hydroxytryptamine(5-HT)and norepinephrine(NE)levels before and 7 d after surgery,National Institutes of Health stroke scale(NIHSS)scores and scandinavian stroke scale(SSS)scores before and 30 d after surgery,as well as the prognosis 30 d post-surgery between the two groups.Results There were no statistically significant differences between the two groups in terms of surgery duration,hematoma clearance rate,intraoperative blood loss,hospital stay,and re-bleeding rates(P>0.05).At 7 d post-surgery,both groups showed a significant increase in serum 5-HT and NE levels compared to pre-surgery,with higher levels observed in the cerebral sulcus fissure group than in the cerebral gyrus cortex group,with statistical significance(P<0.05).At 30 d post-surgery,both groups had significantly lower NIHSS scores and higher SSS scores compared to pre-surgery,with the cerebral sulcus fissure group showing lower NIHSS scores and higher SSS scores than the cerebral gyrus cortex group,with statistical significance(P<0.05).The favorable prognosis rate of the cerebral sulcus fissure group(94.12%)was higher than that of the cerebral gyrus cortex group(66.66%),with statistical significance(P<0.05).Conclusion The efficacy of ultra-early microsurgery through the cerebral sulcus fissure for the treatment of basal ganglia hemorrhage is superior to that of microsurgery through the cerebral gyrus cortex,which can reduce the inhibition of 5-HT and NE,and help the recovery of neurological function.