不同手术入路治疗早期左侧壳核出血的临床效果  

Clinical efficacy of different surgical approaches in the treatment of early left putamen hemorrhage

作　　者：陈伟强[1] 彭国毅 杨金华[1] 肖哲[1] 张子衡[1] 罗成[1] 

机构地区：[1]汕头大学医学院第一附属医院神经外科,广东汕头515041

出　　处：《中国医药导报》2016年第17期62-64,72,共4页China Medical Herald

基　　金：广东省科学事业费计划项目(2009B030801327)

摘　　要：目的探讨不同手术入路治疗高血压性左侧壳核出血的效果。方法选择2003年1月-2009年12月于汕头大学医学院第一附属医院（以下简称＂我院＂）早期急诊行经侧裂-岛叶入路显微手术清除血肿的69例高血压性左侧壳核出血患者作为观察组,选择我院同期行经颞叶皮质入路手术治疗的58例患者作为对照组。观察两组患者血肿清除率、再出血发生率、术后失语情况及术后3个月的预后情况。结果观察组大部分血肿清除率高于对照组[69.6%（48/69）比44.8%（26/58）],再出血发生率低于对照组[10.2%（7/69）比31.0%（18/58）],观察组患者未见完全失语者,无失语率明显高于对照组[71.0%（49/69）比3.5%（2/58）],两组比较差异均有统计学意义（P〈0.05）。术后3个月随访,观察组预后优良率明显高于对照组[63.8%（44/69）比32.8%（19/58）],两组比较差异有统计学意义（P〈0.05）。结论经外侧裂-岛叶入路治疗高血压性壳核出血的效果优于经颞叶皮质入路,其具有血肿清除效果好、止血方便、对脑组织损伤小、对语言功能的影响小等优势,值得临床推广应用。Objective To investigate the efficacy of different surgical approaches in the treatment of hypertensive left putamen hemorrhage. Methods Sixty nine cases of patients with hypertensive left putamen hemorrhage underwent early microsurgery via transsylvian fissure-insular approach to remove hematoma in the First Affiliated Hospital of Shantou University Medical College from January 2003 to December 2009 were selected as observation group, 58 patients underwent microsurgery via temporal lobe cortex approach at the same time in our hospital were selected as control group.The hematoma clearance rate, incidence of rehaemorrhagia, postoperative aphasia and the prognosis at three months after operation in the two groups were observed. Results The most hematoma clearance rate of observation group was higher than that of control group [69.6%（48/69） vs 44.8%（26/58）], the incidence of rehaemorrhagia was lower than that of control group [10.2%（7/69） vs 31.0%（18/58）], observation group had no patients with total aphasia, the incidence of no aphasia in observation group was higher than that of control group [71.0%（49/69） vs 3.5%（2/58）], the differences between the two groups were all statistically significant（P〈0.05）. Followed-up at postoperative 3 months, the excellent rate of prognosis in the observation group was higher than that of control group [63.8%（44/69） vs 32.8%（19/58）], the difference between the two groups was statistically significant（P〈0.05）. Conclusion The effect of hypertensive putamen hemorrhage via transsylvian fissure-insular approach is better than the temporal lobe cortex approach,which has the advantages of good hematoma removal effect, convenient hemostasis, small damage for brain tissue, small influence for linguistic function, and so on, which is worthy of clinical promotion and application.

关 键 词：壳核出血 高血压 侧裂-岛叶入路 颞叶皮质入路 显微外科手术 

分 类 号：R743.34[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]