个体化选择侧裂解剖点手术治疗高血压性基底节区脑出血  

Individual microsurgical treatment of hypertensive basal ganglia hematomas via different sylvian anatomical points

作　　者：崔永华[1] 夏咏本[1] 王张明[1] 陈恒林[1] 韩清[1] Cui Yonghua;Xia Yongben;Wang Zhangming;Chen Henglin;Han Qing(Department of Neurosurgery, Jianhu Hospital Affiliated to Nantong University, Jianhu, Jiangsu 224700, China)

机构地区：[1]南通大学附属建湖医院神经外科,224700

出　　处：《中国基层医药》2019年第10期1161-1163,共3页Chinese Journal of Primary Medicine and Pharmacy

基　　金：江苏省卫生计生委医改试点单位科研课题(YG201512).

摘　　要：目的探讨"个体化"选择侧裂解剖点、经侧裂-岛叶入路手术治疗高血压性基底节区脑出血的疗效。方法回顾性分析2014年10月至2016年6月南通大学附属建湖医院采用"个体化"选择侧裂解剖点显微手术治疗的高血压性基底节区脑出血患者45例的临床资料。结果血肿偏前的经侧裂前点解剖,占66.7%(30例),血肿偏后的经侧裂下Rolandic点解剖,占22.2%(10例)、长轴型的经侧裂前点与下Rolandic点间解剖,占11.1%(5例);术后第l天颅脑CT示血肿清除>90.0%有42例,>75.0%有3例,无术后再出血病例;术后6个月根据格拉斯哥预后评分,恢复良好14例,中残20例,重残9例,植物生存1例,死亡1例。结论"个体化"选择侧裂解剖点、经侧裂-岛叶入路显微手术是治疗高血压性基底节区脑出血安全有效的方法,具有脑组织损伤小、血肿清除率高、神经功能恢复好等优点。Objective To study the surgical strategy and clinical efficacy of hypertensive basal ganglia hematomas via transsylvian transinsular approach individually. Methods The clinical data of 45 patients with hypertensive basal ganglia hematomas underwent microsurgical treatment with different sylvian anatomical points in Jianhu Hospital Affiliated to Nantong University from October 2014 to June 2016 were retrospectively analyzed. Results The anterior hematomas was dissected through anterior point of lateral fissure, accounted for 66.7%(30 cases), the posterior hematoma was dissected through rolandic points under lateral fissure, accounted for 22.2%(10 cases), the long axis type hematoma was dissected between the anterior point of the lateral fissure and the lower rolandic point, accounted for 11.1%(5 cases). The postoperative CT scan showed that 42 cases were removed the hematomas for more than 90.0%, 3 cases were removed the hematomas for more than 75.0%, there was no postoperative rebleeding.According to GOS score, 14 cases returned to preoperative life status, 20 cases recovered sufficiently to return to family life, 9 cases could ambulate with a crotch but needed assistance, one case showed vegetative survival, one patient died. Conclusion Transsylvian transinsular approach via individual sylvian anatomical point should be advocated to remove basal ganglia hematomas, and it has the advantages of minimally invasion, high hematoma evacuation rate, low rebleeding rate, good neurological recovery and so on.

关 键 词：颅内出血 高血压性 显微外科手术 颅骨切开术 血肿 格拉斯哥预后评分 

分 类 号：R651.1[医药卫生—外科学]