小骨窗开颅侧裂-岛叶入路显微手治疗基底节区HICH患者的效果及方法  

Microsurgical Treatment of Basal Ganglia HICH Patients with Small Bone Flap Craniotomy and Transsylvian Transinsular Approach

作　　者：刘桂林[1] LIU Guilin(Department of Neurosurgery, Renhe Hospital, Beijing 102600,China)

机构地区：[1]北京市仁和医院神经外科,北京102600

出　　处：《解放军预防医学杂志》2018年第12期1550-1553,共4页Journal of Preventive Medicine of Chinese People's Liberation Army

摘　　要：目的探讨小骨窗经外侧裂与岛叶入路显微手术联合治疗基底节区高血压脑出血(HICH)患者的效果。方法选取2014年1月-2017年3月于我院行手术治疗的100例HICH患者,根据手术方法分为研究组(50例)和对照组(50例),研究组采用小骨窗经外侧裂与岛叶入路显微手术治疗,对照组采用传统经颞叶皮层入路手术血肿清除术;对比两组的手术时间、术中出血量、血肿清除率、二次手术率,对比两组患者术前、术后7 d、术后14 d的格拉斯哥昏迷评分(GCS)、术后不同时间点巴氏指数(Barthel)、并发症。结果研究组的手术时间、术中出血量显著低于对照组(P<0.05);研究组的血肿清除率显著高于对照组(P<0.05);两组患者的二次手术率差异不具有统计学意义(P>0.05);术前,两组患者的GCS评分差异不具有统计学意义(P>0.05);术后7 d、术后14 d,两组患者的GCS评分较术前均显著提高(P<0.05);在术后7d时,研究组的GCS评分显著高于对照组(P<0.05);术后28 d、术后3个月,研究组患者的BI指数均显著高于对照组(P<0.05);术后6个月,两组患者的BI指数差异不具有统计学意义(P> 0.05);研究组的并发症率16.00%与对照组的28.00%比较,差异不具有统计学意义(P>0.05)。结论小骨窗经外侧裂与岛叶入路显微手术联合治疗基底节区HICH具有血肿清除率高、手术时间短、术后患者昏迷程度恢复快、日常生活活动能力恢复快的特征。Objective To investigate the therapeutic effect of small bone flap craniotomy combined with the transsylvian transinsular approach against hypertensive cerebral hemorrhage( HICH) in basal ganglia. Methods One hundred patients with HICH who underwent surgery between January 2014 and March 2017 were enrolled in this study. According to the surgical method,50 patients were assigned to the study group and another 50 to the control group. The study group was treated with small bone flap craniotomy combined with the transsylvian transinsular approach,while the control group was treated with traditional hemorrhoidectomy for hemorrhage. The duration of surgery,intraoperative blood loss,hematoma clearance rate and secondary operation rate were compared between the two groups before surgery and 7 days after surgery,so were Glasgow Coma Scale( GCS) 14 days after surgery,Barthel at different time points after surgery and complications.Results The duration of surgery and intraoperative blood loss of the study group were significantly shorter or lower than those of the control group( P<0.05). The hematoma clearance rate of the study group was significantly higher than that of the control group( P<0.05). The difference in the secondary operation rate between the two groups was not statistically significant( P>0.05),neither was the difference of GCS scores between the two groups( P>0.05). There was significant increase of GCS scores in both groups after treatment( P<0.05). At 7 days postoperatively,the GCS score of the study group was significantly higher than that of the control group( P<0.05). The BI index of the study group was significantly higher than that of the control group 28 days and 3 months after surgery( P<0.05). There was no significant difference in the BI index between the two groups( P > 0. 05). The rate of complications of the study group was16.00%,compared with 28.00 of the control group,so the difference was not statistically significant( P>0.05).Conclusion Small bone flap craniotomy combined with microsurger

关 键 词：小骨窗 经外侧裂与岛叶入路显微手术 基底节区 高血压脑出血 

分 类 号：R743.4[医药卫生—神经病学与精神病学]