直切口小骨窗经侧裂入路显微手术对高血压基底节脑出血患者水肿带变化及脑脊液细胞因子的影响  

Effects of straight incision and small bone window lateral fissure approach microsurgery on edema area and cytokines in cerebrospinal fluid of patients with hypertensive cerebral hemorrhage in basal ganglia

作　　者：浦志一[1] 

机构地区：[1]江苏省宝应县人民医院脑外科,225800

出　　处：《河北医药》2017年第24期3704-3707,共4页Hebei Medical Journal

摘　　要：目的探究直切口小骨窗经侧裂入路显微手术对高血压基底节脑出血(HBGH)水肿带变化及脑脊液细胞因子的影响。方法选取2014年1月至2016年1月所收治的80例患者,随机分为观察组和对照组,每组40例。对照组患者采用骨瓣开颅皮层造瘘入路手术治疗,观察组患者采用直切口小骨窗经侧裂入路手术治疗,比较2组治疗前后围手术期指标变化情况;比较2组患者神经功能和日常生活能力恢复情况,并对2组患者术后水肿带和脑脊液细胞因子的变化情况进行比较。结果观察组患者手术时间、术中出血量、住院时间、并发症显著优于对照组,差异有统计学意义(P<0.05),2组血肿清除率比较差异无统计学意义(P>0.05);观察组患者神经功能和日常生活能力恢复情况显著优于对照组,差异有统计学意义(P<0.05);2组患者TNF-α、IL-4、6-K-PGF1α自术后12 h开始含量均升高,到3 d时达到最高值,随后各指标逐渐开始下降,且观察组各指标均显著低于对照组,2组比较差异有统计学意义(P<0.05)。结论采用直切口小骨窗经侧裂入路显微手术治疗HBGH能够显著减少手术时间和术中出血量,改善患者水肿带和脑脊液细胞因子水平,改善患者生存质量,是一种理想的治疗方法。Objective To observe the effects of straight incision and small bone window lateral fissure approach microsurgery on edema area and cytokines in patients with hypertensive cerebral hemorrhage in basal ganglia（ HBGH）.Methods Eighty patients with HBGH who were admitted and treated in our hospital from January 2014 to January 2016 were randomly divided into observation group and control group,with 40 patients in each group. The patients in control group were treated by craniotomy cortex fistula approach microsurgery,however,the patients in observation group were treated by transsylvian approach microsurgery via straight incision,then the changes of perioperative parameters,the recovery status of neurological function and daily life ability,the changes of cytokines in cerebrospinal fluid and edema area before and after treatment were observed and compared between two groups. Results The operation time,intraoperative bleeding volume,hospitalization time,complications in observation group were superior to those in control group（ P 0. 05）. However there was no significant difference in hematoma clearance rate between two groups（ P 0. 05）. The recovery status of neurological function and daily life ability in observation group were significantly better than those in control group（ P 0. 05）. The levels of TNF-alpha,alpha IL-4,6-K-PGF1 were increased from 12 h after operation,which reached peak on the third day,then these indexes were gradually decreased,moreover,which in observation group were significantly lower than those in control group（ P 0. 05）. Conclusion The transsylvian approach microsurgery via straight incision in treatment of HBGH can obviously decrease operation time and intraoperative bleeding volume,and improve the cytokine levels in edema area and cerebrospinal fluid,improve the life quality of patients,therefor,which is an ideal treatment method.

关 键 词：侧裂入路显微手术 高血压基底节脑出血 水肿带 脑细胞因子 

分 类 号：R743.34[医药卫生—神经病学与精神病学]