经侧裂-脑岛入路显微手术治疗壳核区高血压脑出血  

Microscopical Surgical Treatment of Hypertensive Putaminal Hematomas through Transsylvian Transinsular Approach

作　　者：熊文浩[1] 葛建伟[1] 张晓华[1] 贾峰[1] 邱永明[1] 李善泉[1] 罗其中[1] 

机构地区：[1]上海交通大学医学院仁济医院神经外科,上海200127

出　　处：《上海交通大学学报（医学版）》2006年第8期937-939,共3页Journal of Shanghai Jiao tong University:Medical Science

摘　　要：目的 观察经侧裂-脑岛入路超早期显微手术治疗壳核区高血压脑出血的效果。方法 2002年1月～2005年8月，37例高血压壳核区脑出血患者，均在发病7h内（超早期）施行经侧裂-脑岛入路显微手术清除壳核区血肿，合并脑室内血肿者辅以脑室外引流术。其中小骨窗手术12例，骨瓣开颅25例。术后复查头颅CT了解血肿清除情况，统计生存率，并以日常生活活动（ADL）分级随访评价患者神经功能恢复状况。结果 术后24～28h头颅CT示：32例患者血肿清除〉90％，5例患者血肿清除〈70％。随访6～12月，37例中生存35例，死亡2例。生存的35例患者中，恢复良好（ADL1～2级）26例（70．3％），中残（ADL3级）4例（10．8％），重残（ADL4级）4例（10．8％），植物生存1例（2．7％）。结论 经侧裂-脑岛入路显微手术确切保护脑血管及脑组织减少神经功能缺失，是治疗壳核区高血压脑出血行之有效的方法。Objective To explore the effects of microscopical surgical treatment on patients with hypertensive putaminal hemorrhage through transsylvian transinsular approach. Methods From January 2002 to August 2005, thirty-seven patients with hypertensive putaminal hemorrhage received microscopical operation through transsylvian transinsular approach within 7 hours from the onset of the symptoms. According to the image of CT scan, hematoma within putamina area was removed with skull flap or skull window craniotomy, and intraventricular hematoma was also performed ventricular puncture and drainage. Results The postoperative CT scan showed that 32 patients was removed the hematoma for more than 90% , while 5 patients less than 70%. During the follow up of 6 to 12 months, 35 patients survived and 2 died. The therapeutic effects were evaluated by activities of daily living （ADL）. There were good recovery or mild disablement （ADL scale 1-2） in 26 cases （70.3%）, moderate disablement （ADL scale 3） in 4 cases （10.8%）, severe disablement （ ADL scale 4） in 4 cases （ 10.8% ）, and persistent vegetative state in 1 case （2.7%）. Conclusion Microscopical operation through transsylvian transinsular approach is an effective method, which could protect cerebral vessels and brain tissues so as to decrease the deficit of nervous function.

关 键 词：脑出血 侧裂-脑岛入路 显微手术 壳核 

分 类 号：R651.1[医药卫生—外科学]