经脑沟裂入路治疗高血压基底核脑出血  

Treatment of intracerebral hematomas in basal ganglia region via transsylvian fissure or cortical sulci-insular approach

作　　者：高志波[1] 钱令涛[1] 陈彬[1] 高心保[1] 梁卫东[1] 王永志[1] 朱司阳 

机构地区：[1]安徽省阜阳市人民医院神经外科,236004

出　　处：《中华解剖与临床杂志》2014年第2期121-125,共5页Chinese Journal of Anatomy and Clinics

摘　　要：目的 探讨经外侧裂及脑沟回裂入路治疗基底核区脑出血对减少术后并发症、改善预后的作用。方法 利用尸头研究外侧裂以及额、颞叶部分脑沟的解剖,并回顾性分析经外侧裂入路手术治疗的14例、经脑沟回裂入路手术治疗的21例和经脑回皮层手术治疗的38例基底核区脑出血患者的临床资料。统计学分析明确3种方法是否具有可比性,并对比研究3种治疗方法的治疗效果。结果 经脑外侧裂组与经脑沟回裂组预后差异无统计学意义（P＞0.05）,两组与经颞叶皮层手术组比较差异均有统计学意义（P值均＜0.05）,经外侧裂与经脑沟回裂入路较经脑回皮层入路血肿清除率高、术后恢复好、术后出现失语及癫痫可能性低。结论 利用脑沟裂自然间隙入路治疗高血压基底核出血是切实可行的,且经外侧裂与经脑沟回裂入路手术优于经脑回皮质入路,该入路对正常脑组织损伤小、治疗效果好,对基底核出血可考虑首选。Objective To explore the therapeutic effects on cerebral hematomas in basal ganglia region via transsylvian fissure or cortical sulci in order to reduce the postoperative complications of the patient with cerebral hemorrhage. Methods To study the anatomy of transsylvian fissure and partial cortical sulci in frontal lobe and temporal lobe by using the heads of dead bodies. The clinical data of 14 patients with hypertensive basal ganglia hemorrhage treated via lateral fissure, 21 patients with hypertensive basal ganglia hemorrhage treated via brain fold fissure approach and 38 patients with hypertensive basal ganglia hemorrhage treated via cortex were analyzed retrospectively. Results There was no difference in prognosis between the group via lateral fissure approach and the group via brain fold fissure approach（P＞0.05）. However,these two groups were different with the group via cortex in prognosis（all P values＜0.05）. Clearing intracerebral hematomas in basal ganglia region via fissure or cortical sulci-insular could occupy shorter operating time, get higher clearance rate of hematomas, gain better postoperative recovery, get lower occurrence rate of anepia and epilepsy after operation than through cortex. Conclusions It is feasible to treat intracerebral hematomas in basal ganglia region via transsylvian fissure or cortical sulci near lateral fissure which is the natural fissure in the brain. And it can treat cerebral hematomas in basal ganglia region effectively without heavy damage of normal brain tissue and can get satisfactory therapeutic efficacy.

关 键 词：脑出血 基底核区 经脑沟回裂入路 经外侧裂入路 

分 类 号：R651.1[医药卫生—外科学]