微骨窗经侧裂—岛叶入路治疗高血压壳核出血临床研究  

Surgical treatment of hypertensive putaminal hematomas through transsylvian-insular approach

作　　者：张伟[1] 张东[2] 杨利军[1] 

机构地区：[1]石家庄市第一医院,石家庄050011 [2]北京天坛医院

出　　处：《山东医药》2010年第28期63-65,共3页Shandong Medical Journal

摘　　要：目的探讨微骨窗经侧裂—岛叶入路血肿清除术治疗高血压壳核出血(HPH)的临床疗效。方法选择HPH患者63例,出血量39～120 ml、平均66 ml。所有患者就诊时未出现脑疝征象。行微骨窗经侧裂—岛叶入路40例,行微骨窗皮质造瘘血肿清除术23例。结果行微骨窗侧裂—岛叶入路的40例患者在72 h内清醒34例,14 d内清醒1例,持续昏迷3例,21 d内死亡2例。行微骨窗皮质造瘘的23例患者术后72 h内清醒13例,14 d内清醒4例,持续昏迷5例,23 d内死亡1例。左侧优势半球血肿患者经侧裂入路手术语言功能好于经皮质造瘘者。结论对于适当的病例选择微骨窗经侧裂—岛叶入路手术有利于更好的功能恢复。Objective To investigate the clinical effects of hypertensive putaminal hematomas（HPH） through transsylvian-insular approach.Methods Sixty-three patients of HPH with volume of hematomas from 39 to 120 ml average 66 ml were enrolled.All patients have no signs of herniation.There were 23 patients received transcortical surgical treatment and 40 patients received transsylvian-insular approach to remove the hematomas.Results Of the 40 patients who with transsylvian-insular approach,34 patients sobered in postoperative 72 hours,1 sobered in postoperative 14 days,3 lapsed into a persistent coma state and 2 died in postoperative 21 days.Of the 23 patients who received transcortical surgical treatment,13 patients sobered in postoperative 72 hours,4 sobered in postoperative 14 days,5 lapsed into a persistent coma state and 1 died in postoperative 23 days.For the language function of the patients with left hemispheric dominance hematoma,patients with transsylvian-insular approach were better than those who received transcortical surgical treatment.Conclusion Transsylvian-insular approach is a better choice for patients with limited extra-capsular type hematoma by which there will be a better preoperative neurological condition.

关 键 词：高血压 壳核出血 脑出血 经侧裂—岛叶入路 

分 类 号：R651.1[医药卫生—外科学]