术中B超在小骨窗经侧裂显微手术治疗高血压基底节区脑出血的应用价值  

Clinical value of microsurgery with small bone flap craniotomy and lateral fissure approach in treatment of hypertensive cerebral hemorrhage in basal ganglia region assisted by intraoperative B-mode ultrasound

作　　者：邓峰[1] 韩方华[2] 叶长空[3] 邓仁智 王光绿[1] 罗大山[1] 

机构地区：[1]广西北海市人民医院神经外科 [2]广西北海市第二人民医院神经外科 [3]广西北海市人民医院超声诊断科,北海536000

出　　处：《右江医学》2016年第5期517-521,共5页Chinese Youjiang Medical Journal

基　　金：北海市科学研究与技术开发计划项目(北科合201303050)

摘　　要：目的探讨在术中实时B 超引导下小骨窗开颅经侧裂显微手术治疗高血压基底节区脑出血的临床价值. 方法选择60例高血压基底节区脑出血患者,随机分为研究组及对照组,研究组采用术中实时B 超监测引导小骨窗开颅经侧裂显微手术清除血肿,对照单纯采用常规小骨窗开颅经侧裂显微手术清除血肿,对比两组患者手术血肿清除情况及治疗效果.结果所有患者术后24 h 内复查头颅CT,研究组血肿清除率〉8 5 %者 2 4例（80.0%）,50%- 85%者4例（13.33%）,〈50%者2例（6.67%）;对照组血肿清除率〉85%及50%-85%者均为13例（43.33%）,小于 50%者4例（13.33%）;两组血肿清除率比较差异有统计学意义（Z=-2.746,P=0.006）.存活者术后随访6个月,研究组术后恢复达Ⅲ级以下者21例（70.0%）,Ⅳ级以上及死亡者9例（30.0%）;对照组术后恢复达Ⅲ级以下者13例 （43.33%）,Ⅳ级以上及死亡者17例（56.67%）;两组恢复良好率比较差异有统计学意义（χ^2=4.344,P=0.037）.结论 术中实时B 超引导下小骨窗开颅经侧裂显微手术治疗高血压基底节区脑出血可提高手术血肿清除率,减少脑组织损伤,改善病人预后.Objective To investigate the clinical value of microsurgery with small bone flap craniotomy and lateral fissure approach in the treatment of hypertensive cerebral hemorrhage in basal ganglia region assisted by intraoperative B-mode ultra-sound. Methods 60 cases of hypertensive cerebral hemorrhage in basal ganglia region were randomly divided into study group and control group.The study group were treated by microsurgery^ with small bone flap craniotomy and lateral fissure ap-proach hematoma evacuation assisted by intraoperative B-mode ultrasound, but the control group were only treated by micro-surgery, with small bone flap craniotomy and lateral fissure approach hematoma evacuation.And then, hematoma evacuation and therapeutic effect of the two groups were compared. Results All the patients were given the CT scan within 24 hours af-ter operation.In the study group,hematoma clearance rate〉85% was found in 24 cases （80.0%）,50% - 85% in 4 cases （13. 33%）,and 〈50% in 2 cases （6.67% ） .In the control group, both the hematoma clearance rate〉85% and 50% - 85% were found in 13 cases（43.33%）, and〈50% in 4 cases（ 13.33%） .Difference of the hematoma clearance rate was statistically significant between the two groups（Z = -2.746,P = 0.006）.The survivors were given 6 months of follow-up visit after opera-tion,which found that postoperative recovery of 21 cases（70.0%） was below grade Ⅲ,and over grade Ⅳ postoperative recov-ery and death were found in 9 cases（ 30.0%） in the study group. How, ever, in the control group,postoperative recovery of 13 cases（43.33%） was below grade Ⅲ, and over grade Ⅳ postoperative recovery and death were found in 17cases（ 56.67%）. Difference of good recovery rate of the two groups was statistically significant（χ^2 =4.344,P= 0.037） . Conclusion Intraoper-ative real-time B-mode ultrasound can rise the hematoma clearance rate

关 键 词：B超引导 小骨窗开颅 侧裂 显微手术 高血压脑出血 基底节区 

分 类 号：R544.1[医药卫生—心血管疾病] R651.1[医药卫生—内科学]