经外侧裂入路基底节区血肿清除术的切口改良探索及临床效果分析  

Incision improvement of lateral fissure approach for hypertensive basal ganglia hematoma and its clinical efficaly analysis

作　　者：黄传平[1] 刘剑[1] 汪先兵[1] 林煜[1] 

机构地区：[1]解放军第四二一医院神经外科,广州510318

出　　处：《中华神经医学杂志》2013年第4期405-408,共4页Chinese Journal of Neuromedicine

摘　　要：目的探讨经外侧裂人路基底节区高血压脑出血手术u型切口的改良方法及临床意义。方法自2007年8月至2012年7月解放军第四二一医院神经外科采用经外侧裂岛叶人路清除基底节区高血压脑出血患者共52例（发病后7h内手术28例，7N24h手术18例，大于24h手术6例），手术中为更好暴露外侧裂长度，采取前斜300U型皮瓣形成椭圆形骨窗，骨窗后部过外侧裂中部之后。结果术后24h内复查头颅CT示血肿彻底清除42例，血肿残留量〈10mL6例．血肿残留量〉10mL4例。术后7d内死亡6例，均为严重肺部感染。存活的46例患者术后6个月GOS评分为良好28例、中残11例、重残3例、植物生存2例、死亡2例。结论对基底节区高血压脑出血患者采取改良切口经外侧裂入路清除血肿，可以减少手术时间，提高血肿清除率。Objective To discuss a modified U-shaped incision method for lateral fissure approach to operate hypertensive basal ganglia hemorrhage and its clinical significance. Methods Fifty-two patients, admitted to and performed removal of hypertensive basal ganglia hematomas via lateral fissure by using U modified incision and small bone craniotomy in our hospital from August 2007 to July 2012, were chosen in our study; the operating time from onset to operation was within 7 hours in 28 patients, between 7-24 h in 18 patients, and longer than 24 h in 6 patients. Results Twenty-four hours after the operation, head CT showed that complete evacuation of hematoma was achieved in 42 patients, hematoma residues smaller than 10 mL in 6 patients and larger than 10 mL in 4 patients. Serious pulmonary infection resulted in death in 6 patients within 7 days of operation. GOS 6 months after operation indicated that good recovery was noted in 28 patients, moderate disability in 11, severe disability in 3, vegetative state in 2 and death in 2. Conclusion A modified U-shaped incision for lateral fissure approach to operate hypertensive basal ganglia hemorrhage can improve the hematoma clearance rate and reduce the operating time.

关 键 词：高血压脑出血 基底节 改良切口 显微外科手术 

分 类 号：R651.1[医药卫生—外科学]