经侧裂入路显微手术治疗基底节区出血48例临床效果观察  

Micrurgy for basal ganglia hemorrhage via transsylvian approach

作　　者：王振宇[1] 黄光富[1] 李志立[1] 唐健[1] 

机构地区：[1]四川省医学科学院.四川省人民医院神经外科,四川成都610072

出　　处：《实用医院临床杂志》2011年第6期136-138,共3页Practical Journal of Clinical Medicine

基　　金：四川省卫生厅科技计划项目(编号:303.005.002.280.015)

摘　　要：目的探讨经侧裂入路显微手术治疗基底节区出血的临床疗效。方法 48例基底区出血患者采用经侧裂入路显微手术治疗,所有患者术前经头部CT检查均发现基底节区血肿,血肿量25～60 ml,其中5例伴侧裂池少量蛛网膜下腔出血,血肿量25～45 ml者37例(30 ml以下7例),45～60 ml者11例。结果 48例患者中血肿清除超过90%者36例,再出血4例,术中发现有明确出血小血管21例,中动脉瘤破裂出血6例。术后1周内意识明显改善、瘫痪好转者27例。随访8～32月,死亡3例,其余45例患者日常生活能力评分(ADL)I级23例,Ⅱ级10例,Ⅲ级7例,IV级4例,V级1例。结论侧裂入路显微手术是治疗基底节区出血较为理想手术方式,临床效果满意。Objective To discuss the micrurgy of basal ganglia hemorrhage via transsylvian approach.Methods Forty-eight patients with basal ganglia hemorrhage underwent micrurgy via transsylvian approach.Basal ganglia hemorrhage was inspected in all cases by cranial computed tomography,with hematoma volume as 25~60 ml.Among them,5 cases were associated with sylvian fissure subarachnoid hemorrhage.There were 37 cases with hematoma volume ranging from 25 ml to 45 ml（7 cases with hematoma volume under 30 ml）,and 11 cases with hematoma volume ranging from 45 ml to 60 ml.Results More than 90% of intracranial hematoma were evacuated in 36 cases.Rehaemorrhagia occurred in 4 cases.Clear bleeding small vessels were found in 21 patients during operation.Ruptured middle cerebral artery aneurysm was found in 6 cases.One week after operation,consciousness and palsy were improved in 27 cases.After follow up for 8~32 months,3 patients died.Of the remaining 45 patients,23 got grade I in activity of daily living（ADL） scale,10 got grade Ⅱ,7 got grade Ⅲ,4 got grade IV,and 1 got grade V.Conclusions Micrurgy via transsylvian approach for patients with basal ganglia hemorrhage is an ideal method with satisfying outcome.

关 键 词：脑出血 侧裂入路 基底节区 显微手术 

分 类 号：R651[医药卫生—外科学] R743.34[医药卫生—临床医学]