无牵拉技术辅助下经侧裂-岛叶入路显微手术治疗基底核区高血压性脑出血  

Microsurgical treatment of hypertensive cerebral hemorrhage in the basal ganglia region via transsylvian-transinsular approach assisted by non-distraction technique

作　　者：田海龙[1] 王益华[1] 何伟[1] 姜彬[1] 黄德章[1] 殷鑫[1] 王超超[1] 王志刚[1] Tian Hailong Wang Yihua He Wei Jiang Bin Huang Dezhang Yin Xin Wang Chaochao Wang Zhigang(Department ofNeurosurgery, Qilu Hospital of Shandong University, Qingdao, Shandong 266000, Chin)

机构地区：[1]山东大学齐鲁医院(青岛)神经外科,青岛266000

出　　处：《中国微侵袭神经外科杂志》2017年第1期7-10,共4页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：山东大学齐鲁医院(青岛)科研启动基金(编号:QDKY2015LH01);青岛市医疗卫生优秀青年医学人才计划

摘　　要：目的探讨无牵拉技术辅助下经侧裂-岛叶入路显微手术治疗基底核区高血压性脑出血的临床效果。方法回顾性分析63例基底核区高血压性脑出血病人的临床资料,微侵袭组34例病人采用无牵拉技术辅助下经侧裂-岛叶入路,对照组29例采用经颞叶皮质造瘘血肿清除术。比较两组病人术后血肿清除率、1个月内再出血率、术后第1周脑水肿程度和术后6个月随访结果。结果与对照组比较,微侵袭组血肿残留量少,血肿清除率高,术后1周颅内压监测值低(P=0.02,0.04,0.01)。两组术后1个月内再出血发生率和6个月内病死率差异无统计学意义(P=0.73,0.98)。微侵袭组病人术后6个月GOS和ADL评分高于对照组(P=0.03,0.02)。微侵袭组病人发病至手术之间时间短,血肿体积小者,术后6个月生活质量较高(P<0.05)。结论无牵拉技术辅助下经侧裂-岛叶入路手术治疗基底核区高血压脑出血,手术损伤小,可有效保护病人神经功能并提高病人术后生活质量。Objective To investigate the clinical efficacy of microsurgical treatment via transsylvian-transinsular approach assisted with non-distraction technology for hypertensive cerebral hemorrhage in the basal ganglia region. Methods Clinical data of 63 patients with intracerebral hemorrhage in the basal ganglia region were ananlyzed retrospectively. The microsurgery assisted by non-distraction was performed via transsylvian-transinsular approach on 34 patients as microsurgery group and temporal cortical fenestration for hematoma clearance was performed on 29 patients as control group. The hematoma clearance rate, rebleeding rate 1 month after surgery, brain edema grade 1 week after surgery and follow-up results 6 months after surgery were compared between two groups. Results Compared with control group, residual hematoma was less, hematoma clearance rate was higher and intracranial pressure 1 week after surgery was lower in the microsurgery group（P = 0.02, 0.04, 0.01）. There were no statistical difference in rebleeding rate 1 month after surgery and mortality rates 6 months after surgery between the two groups（P = 0.73, 0.98）. GOS and ADL scores 6 months after surgery were higher in microsurgery group than in control group（P = 0.03, 0.02）. The shorter the onset-operation time, and the smaller the hematoma volume were, the higher the living quality 6 months after surgery in microsurgery group would be（ P〈0.05）. Conclusion Transsylviantransinsular approach assisted by non-distraction technique for hypertensive cerebral hemorrhage in the basal ganglia region has smaller surgical injury, therefore, can protect neurological function and improve quality-of-life after surgery.

关 键 词：颅内出血 高血压性 入路 经侧裂-岛叶 无牵拉技术 

分 类 号：R651.12[医药卫生—外科学] R544.1[医药卫生—临床医学]