颞叶皮层入路、沟裂显微手术和钻孔引流术治疗幕上高血压脑出血的疗效对比  

Efficacy of temporal cortical approach,fissure microsurgery and trepanation and drainage in the treatment of supratentorial hypertensive intracerebral hemorrhage

作　　者：王常伟[1] 刘德忠 李楷[1] Wang Changwei;Liu Dezhong;Li Kai(Second of Neurosurgery Department,Zhoukou Central Hospital,Zhoukou 466000,China)

机构地区：[1]河南省周口市中心医院神经外科二病区,466000

出　　处：《中国实用医刊》2019年第22期54-58,共5页Chinese Journal of Practical Medicine

摘　　要：目的分析颞叶皮层入路、沟裂显微手术和钻孔引流术治疗幕上高血压脑出血(SICH)的疗效及安全性.方法抽取2016年5月至2018年5月周口市中心医院194例SICH患者作为研究对象,根据手术方案将患者分为颞叶组62例、侧裂组47例和钻孔组85例,比较三组围术期指标、近期和远期手术效果以及术后并发症发生情况.结果三组手术时间、术中出血量及住院时间比较,差异有统计学意义(P<0.05),其中侧裂组手术时间长于颞叶组(P<0.05),术中出血量和住院时间低于颞叶组(P<0.05),且钻孔组手术时间低于颞叶组和侧裂组(P<0.05),术中出血量和住院时间低于颞叶组而且高于侧裂组(均P<0.05),三组血肿清除率比较差异未见统计学意义(P>0.05);三组术后GCS评分均随时间逐渐增高,组内不同时间比较差异有统计学意义(P<0.05),且颞叶组术后1 d、3 d时GCS评分高于钻孔组(P<0.05),侧裂组术后1 d、3 d时GCS评分高于颞叶组和钻孔组(P<0.05);三组术后预后良好率分别为87.10%、91.49%和80.00%(P>0.05),另外颞叶组术后死亡1例(1.61%),侧裂组未发生死亡,钻孔组死亡3例(3.53%),三组手术效果比较差异未见统计学意义(P>0.05);侧裂组肺部感染和癫痫发生率低于颞叶组(P<0.05),三组颅内再出血、应激性溃疡和颅内感染发生率比较差异未见统计学意义(P>0.05).结论颞叶皮层入路、沟裂显微手术和钻孔引流术治疗SICH均具有良好效果,其中沟裂显微手术创伤相对较小,有利于提升近期疗效,减少术后并发症并促进患者康复.Objective To study the efficacy and safety of temporal cortical approach,fissuremicrosurgery and trepanation and drainage in the treatment of supratentorial hypertensive intracerebral hemorrhage(SICH).Methods A total of 194 patients with SICH from May 2016 to May 2018 were chosen as research object.According to surgical procedures,the patients were divided into temporal lobe group(62 cases),lateral fissure group(47 cases)and trepanation group(85 cases).The perioperative indicators,short-term and long-term surgical effects and occurrence of postoperative complications were compared among the three groups.Results There were significant differences in the operative time,intraoperative blood loss and average hospital stay among the three groups(P<0.05).The operative time in lateral fissure group was significantly higher than that in temporal lobe group(P<0.05),and the intraoperative blood loss and average hospital stay were significantly lower than those in temporal lobe group(P<0.05).The operative time in trepanation group was significantly lower than that in temporal lobe group and lateral fissure group(P<0.05),and the intraoperative blood loss and average hospital stay were significantly lower than those in temporal lobe group and higher than those in temporal lobe group(P<0.05),However there was no significant difference in the clearance rate of hematoma among the three groups(P<0.05).The Glasgow Coma Scale(GCS)scores in the three groups were increased gradually with time,and the difference was statistically significant at different time points(P<0.05).The GCS scores in temporal lobe group were higher than those in trepanation group on 1 d and 3 d after operation(P<0.05),and the GCS scores in lateral fissure group on 1 d and 3 d after operation were significantly higher than those in temporal lobe group and trepanation group(P<0.05).The good prognosis rates in the three groups were 87.10%,91.49%and 80.00%respectively(P>0.05).In addition,there was 1 case of death(1.61%)in temporal lobe group,and there was no death

关 键 词：高血压幕上脑出血 颞叶皮层入路 沟裂显微手术 钻孔引流术 疗效 安全性 

分 类 号：R651.1[医药卫生—外科学]