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效果  

Microsurgical treatment of hypertensive cerebral hemorrhage in basal ganglia vis translateral fissure-insula approach assisted by traction-free technique

作　　者：吴小波[1] 张杰[1] 曾礼 张轶行[1] WU Xiao-bo;ZHANG Jie;ZENG Li;ZHANG Yi-xing(Department of Neurosurgery,Fuling Central Hospital of Chongqing City,Chongqing 408099,China)

机构地区：[1]重庆市涪陵中心医院神经外科

出　　处：《中国临床研究》2019年第8期1029-1032,1037,共5页Chinese Journal of Clinical Research

基　　金：重庆市涪陵区科技计划项目(PLKJ,2012ABB1115)~~

摘　　要：目的探讨无牵拉技术辅助下经侧裂-岛叶入路显微手术在基底核区高血压性脑出血中的应用价值。方法选取2015年12月至2018年2月高血压性脑出血患者86例,按随机数字表法分为对照组(n=43)与研究组(n=43)。对照组采取常规大骨瓣开颅血肿清除术,研究组采取无牵拉技术辅助下经侧裂-岛叶入路显微手术。统计两组围术期情况、临床疗效、并发症发生率及手术前后格拉斯哥昏迷量表评分(GCS),并随访6个月,统计两组预后效果、日常生活能力(ADL)评分。结果研究组术中失血量显著少于对照组,术后意识恢复用时、手术时长短于对照组,差异有统计学意义(P<0.01)。研究组治疗总有效率显著高于对照组,差异有统计学意义(93.02%vs76.74%,P<0.05)。术后3d两组GCS评分较术前增高,术后6个月两组ADL评分较术前增高,且研究组GCS评分、ADL评分均高于对照组,差异有统计学意义(P<0.01)。研究组并发症发生率低于对照组,差异有统计学意义(9.30%vs27.91%,P<0.05)。研究组预后优良率高于对照组,差异有统计学意义(88.37%vs69.77%,P<0.05)。结论基底核区高血压性脑出血患者采取无牵拉技术辅助下经侧裂-岛叶入路显微手术治疗,血肿清除效果较好,术中失血量及术后意识恢复用时少,利于减轻昏迷状态,恢复日常生活能力,术后并发症发生率较低,并能显著提高预后优良率。Objective To explore the application value of microsurgery via lateral fissure-insular approach assisted by traction-free technology in the treatment of hypertensive intracerebral hemorrhage in basal ganglia.Methods Eighty-six patients with hypertensive intracerebral hemorrhage from December 2015 to February 2018 were enrolled and randomly divided into control group and study group (n = 43,each).The conventional large bone flap craniotomy for hematoma evacuation was performed in control group,and the microsurgery through the lateral fissure-insular approach with tractionfree technology was conducted in study group.The perioperative conditions,clinical efficacy,complication rate,and Glasgow coma scale (GCS) before and after surgery were compared between two groups.The prognosis and ability of daily living (ADL) scores were observed and analyzed during a 6- month follow-up period.Results The intraoperatine blood loss, time for consciousness recovery after operation and the operative time in study group were significantly shorter than those in control group (P < 0.01 ).The total effective rate in study group was statistically higher than that in control group (93.02% vs 76.74%,P < 0.05).GCS increased 3 days after surgery,and ADL scores increased at postoperative 6 months in both groups,and they were statistically higher in study group than those in control group(P < 0.01).The incidence of complications in study group was significantly lower than that in control group(9.30% vs 27.91%,P < 0.05),and the excellent and good prognosis rate in study group was statistically higher than that in control group (88.37% vs 69.77%, P < 0.05).Conclusions For the patients with hypertensive cerebral hemorrhage in basal ganglia,microsurgery via the lateral fissure-insular approach assisted by traction-free technique has better effect of hematoma clearance less intraoperative blood loss,less time for consciousness recovery after operation,which is conducive to alleviating coma and restoring the ability of daily living,lower incidence

关 键 词：高血压性脑出血 基底核区 无牵拉技术辅助 经侧裂-岛叶入路显微手术 格拉斯哥昏迷量表评分 日常生活能力评分 

分 类 号：R743.34[医药卫生—神经病学与精神病学]