直切口小骨窗经侧裂入路显微手术治疗高血压基底节脑出血的疗效观察  

Clinical observation on efficacy of microsurgery of hypertensive basal ganglia hemorrhage through small craniotomy trans-sylvian approach

作　　者：周良东[1] 夏连贵[1] 陈琳[1] 徐良娣 

机构地区：[1]安徽省池州市人民医院神经外科,247100

出　　处：《安徽医学》2015年第8期966-969,共4页Anhui Medical Journal

摘　　要：目的探讨直切口小骨窗经侧裂入路显微手术治疗高血压基底节脑出血的方法及疗效。方法对64例高血压基底节脑出血患者的临床资料进行回顾性分析,根据不同手术方法分为观察组(直切口小骨窗经侧裂入路血肿清除术)和对照组(骨瓣开颅皮层入路血肿清除术)。比较两组的手术时间、术中出血量、血肿清除率、术后并发症及住院时间、病死率,日常生活活动能力分级(ADL)。结果观察组手术时间短,术中出血及术后并发症少,住院时间短,两组比较差异有统计学意义(P<0.05),术后1年ADL明显优于对照组,差异有统计学意义(P<0.05)。结论对于术前无脑疝及严重高颅压者,直切口小骨窗经侧裂入路显微手术是治疗高血压基底节脑出血较理想的方法,可提高患者存活率,改善生活质量。Objective To study the method and effect of microsurgical treatment on patients with hypertensive basal ganglia hemato-mas(HBGH)through small craniotomy trans-sylvian approach. Methods The clinical data of 64 cases of HBGH patients underwent micro-surgical treatment in our hospital from 2008 to 2013 were retrospectively analyzed. All the patients were treated with open surgical evacuation through small craniotomy trans-sylvian approach or conventional craniotomy approach,and thereby they were divided intotwo groups. The op-eration time,intra-operative blood loss,hematomas clearance rate,postoperative complications,and hospitalization time,mortality,activities of daily living(ADLs)between the two groups were compared. Results Compared with the conventional craniotomy approach group,the small craniotomy trans-sylvian group had lower blood loss,fewerpostoperative complications,shorter time of operation and hospitalization,and the difference was statistically significant(P ﹤ 0. 05). The ADL grade at 12 months after operation was higher in the small craniotomy trans-sylvian group than that in the conventional craniotomy approach group,similarly with significant difference(P ﹤ 0. 05). Conclusion Micro-surgery through trans-sylvian trans-insular approach is an effective treatment for HBGH patients without cerebral hernia or severe intracranial hypertension,and it is characterized by minimal cerebral tissues injury,high hematomas clearance rate and good prognostic nervous function.

关 键 词：小骨窗 高血压 基底神经节 脑出血 外侧裂入路 

分 类 号：R651.1[医药卫生—外科学]