经侧裂-岛叶入路骨瓣复位手术治疗高血压基底节区脑出血  

Hypertensive basal cerebral hemorrhage treated by lateral fissure-island approach and bone flap reduction

作　　者：陈大普 王冬 CHEN Dapu;WANG Dong(Department of Neurosurgery,Pingdingshan Central Hospital,Peking University Medical Group,Pingdingshan 46700,China;Department of Emergency,Wuyishan Municipal Hospital,Wuyishan 354300,China)

机构地区：[1]北大医疗集团平顶山中心医院神经外科,河南平顶山467002 [2]武夷山市立医院急诊科,福建武夷山354300

出　　处：《中国实用神经疾病杂志》2019年第24期2731-2738,共8页Chinese Journal of Practical Nervous Diseases

摘　　要：目的分析高血压基底节区脑出血经侧裂--岛叶入路骨瓣复位手术治疗的临床疗效和预后。方法回顾性分析2016-06-2018-06北大医疗集团平顶山中心医院收治的60例高血压基底节区脑出血患者经侧裂--岛叶入路骨瓣复位手术治疗的临床资料。60例患者术前均有不同程度的意识障碍,均有出血对侧肢体不同程度偏瘫,均采用经外侧裂--岛叶入路骨瓣复位手术治疗,术前均行急诊CT检查,血肿均为基底节区出血内侧型,采用多田公式计算血肿量40~60 mL,患者术前均未形成脑疝,处于嗜睡至浅昏迷状态。结果术后立即清醒18例(30%),24 h内清醒22例(36.6%),48 h内清醒8例(13.3%),72 h内清醒10例(16.7%),无处于昏迷状态患者。术后立即复查CT,提示血肿清除率均在90%以上,术后第一天复査,4例术区有少量渗血,不超过5 mL。随访6~24个月,患者出血对侧下肢肌力达Ⅳ+级以上42例,Ⅳ级以8例,Ⅲ~Ⅳ例10例,无死亡病例。结论高血压基底节区脑出血经侧裂-岛叶入路颅骨复位手术治疗是一种理想的手术方式,不但能大部分清除血肿,且对额颞叶的脑组织损伤极小,术后脑水肿轻。颅骨复位避免了因颅骨缺损而引起的诸多并发症,避免再次手术修补颅骨。患者术后肌力、语言恢复快,后遗症少,并发症少,神经功能恢复良好。Objective To analyze the clinical effect and prognosis of the surgical treatment of hypertensive basal ganglia hemorrhage by lateral fissure-insular approach.Methods The clinical data of 60 hypertensive patients with cerebral hemorrhage in basal ganglia region from June 2016 to June 2018 were retrospectively analyzed.All the 60 patients had different degrees of consciousness disturbance before operation,hemiplegia in the opposite limbs and hemorrhage in the basal ganglia region.All the 60 patients had hypertensive cerebral hemorrhage in the basal ganglia region.All the hematomas were medial hemorrhage in basal ganglia area.The amount of hematoma was calculated by Doda formula.No cerebral hernia was found before operation,and the patients were in a state of lethargy to shallow coma.Results 18 cases(30%)were awake immediately after operation,22 cases(36.6%)were awake within 24 hours,8 cases(13.3%)were awake within 48 hours,10 cases(16.7%)were awake within 72 hours,none of them was in coma.CT examination immediately after operation showed that the clearance rate of hematoma was above 90%.Only 4 cases had little bleeding in the operation area on the first day after operation,not more than 5 mL.Following up for 6-24 months,42 patients with hemorrhagic contralateral lower extremity muscle strength above gradeⅣ,8 patients with gradeⅣ,10 patients with gradeⅢ-Ⅳ,no death.Conclusion Cranial reduction through lateral fissure-insular approach for hypertensive basal ganglia cerebral hemorrhage is an ideal surgical method.This method can not only remove hematoma mostly,but also minimize the damage to frontotemporal lobe brain tissue.The postoperative brain edema is mild.Cranial reduction avoids many complications caused by skull defect and avoids many complications.Re-operation repair of the skull,postoperative muscle strength and language of patients recovered quickly,fewer sequelae,fewer complications,good recovery of nerve function.

关 键 词：基底节区脑出血 高血压 经侧裂岛叶入路骨瓣复位 骨瓣复位 微牵拉 

分 类 号：R743.34[医药卫生—神经病学与精神病学]