经外侧裂岛叶入路与经颞叶皮质入路手术治疗壳核出血的对照研究  

Comparative study of neurosurgical treatment for putamianal hematomas through lateral fissure - insula lobe approach and temporal lobe cortex approach

作　　者：唐晓平[1] 游潮[2] 张涛[1] 彭华[1] 赵龙[1] 杨彬彬[1] 印晓鸿[1] 段军伟[1] 漆建[1] 唐文国[1] 王远传[1] 冯凌[1] 罗仁国[1] 李舜[1] 苟章洋[1] 

机构地区：[1]川北医学院附属医院神经外科,四川南充637000 [2]四川大学华西医院神经外科

出　　处：《中华神经外科杂志》2013年第8期817-820,共4页Chinese Journal of Neurosurgery

基　　金：国家十二五科技支撑计划课题（2011BA108B05）;四川省医学重点建设学科基金资助[川卫办发（2007）407号];四川省卫生厅科研项目资助（070301,090140）;四川省教育厅自然科学基金项目资助（07ZA186）

摘　　要：目的比较分析经外侧裂岛叶入路和经颞叶皮质入路两种手术方式治疗壳核出血的优劣性。方法选择符合标准的壳核出血病例732例，随机分为A组和B组，A组经外侧裂岛叶进入血肿腔，B组经颞叶皮质进入血肿腔。对两组术前临床资料、手术操作、血肿清除量与再出血情况进行比较。结果（1）两组术前情况比较，差异无统计学意义。（2）手术操作比较，经外侧裂岛叶入路进入血肿腔更容易、血肿残腔止血更顺利、对意外发现血管病变处理更方便、去骨瓣减压病例数更少，两组比较差异有统计学意义（P〈0．01）。（3）经侧裂岛叶入路清除血肿95％以上的例数较经颞叶入路为多，再出血例数较经颞叶入路为少，两组比较差异有统计学意义（P〈0．01）。结论手术清除脑壳核血肿，经侧裂岛叶入路较经颞叶皮质入路更符合微创理念，值得临床推广。Objective To compare the neurosurgical treatment for putamianal hemorrhage through lateral fissure - insula lobe approach and temporal lobe cortex approach. Methods 732 cases of cerebral hemorrhage in putamianal area were selected and randomly assigned into group A and group B. The remove of hematoma in group A and group B was adopted by lateral fissure - insular cortex approach and temporal cortex approach, respectively. The preoperative clinical data, surgical operating conditions, removed volume of hematoma and re - bleeding incidence were compared between the two groups. Results （ 1 ） No significant differences were found in preoperative conditions between the two groups. （2）Compared with temporal lobe cortex approach,lateral fissure - insula lobe approach has more merits, such as easier to go into the hematoma cavity and stop bleeding, more convenience to deal with some vascular lesions and less cases of decompressive raniectomy（ P 〈 0. 01 ）. （3） Compared with temporal lobe cortex approach, there were more cases for their hematoma could be cleared over 95%, and less re - bleeding incidence via lateral fissure - insula lobe approach（ P 〈 0. 01 ）. Conclusions To remove putamianal hematoma via lateral fissure - insula lobe approach is more accordant with minimally invasive concept than that via temporal lobe cortex approach, and it is worth spreading widely in clinic.

关 键 词：脑出血 壳核 外科治疗 外侧裂岛叶入路 颞叶皮质入路 

分 类 号：R651.1[医药卫生—外科学]