超早期锁孔开颅经外侧裂显微手术治疗基底节区高血压性脑出血的疗效观察  

Effect of keyhole microscopic craniotomy via lateral fissure in treatment of hypertensive intracerebral hemorrhage in basal ganglia in ultra-early stage

作　　者：邰云飞 曹奕波 余仁春 王泽平 周威 TAI Yunfei;CAO Yibo;YU Renchun;WANG Zeping;ZHOU Wei(Department of Neurosurgery,Yizheng Hospital of Nanjing Drum Tower Hospital Group of Jiangsu Province,Yizheng,Jiangsu,211900)

机构地区：[1]江苏省南京鼓楼医院集团仪征医院神经外科,江苏仪征211900

出　　处：《实用临床医药杂志》2021年第22期99-101,共3页Journal of Clinical Medicine in Practice

摘　　要：目的探讨超早期锁孔小骨窗经外侧裂入路显微手术治疗基底节区高血压性脑出血(HICH)的效果。方法对85例基底节区HICH患者在超早期(发病后6 h内)实施锁孔小骨窗开颅经外侧裂手术。术毕及术后48 h内复查头颅CT,了解血肿清除情况。随访6个月时,采用日常生活能力(ADL)分级评估预后。结果血肿清除量>80%者64例(75.3%)。术后随访6个月,ADL分级包括Ⅰ级13例(15.3%),Ⅱ级37例(43.5%),Ⅲ级25例(29.4%),Ⅳ级5例(5.9%),Ⅴ级3例(3.5%)。术后因并发症死亡2例(2.3%)。结论超早期锁孔小骨窗开颅经外侧裂入路行显微镜下血肿清除术具有创伤小、术中显露好、止血彻底等优点,尤其适用于基底节区中等量出血者,可促进患者后期的神经功能恢复。Objective To investigate the effect of keyhole microscopic craniotomy via lateral fissure in treatment of hypertensive intracerebral hemorrhage(HICH) in basal ganglia in ultra-early stage. Methods A total of 85 patients with HICH in basal ganglia were treated with keyhole microscopic craniotomy via lateral fissure in ultra-early stage(within 6 hours after onset). Immediately and within 48 hours after operation, cranial CT were re-examined to understand the clearance status of hematoma. At 6 months of follow-up, the prognosis was evaluated by Activity of Daily Living(ADL) grading. Results Hematoma clearance volume greater than 80% of total volume was observed in 64 cases(75.3%). The patients were followed up for 6 months, and the ADL classification result included grade Ⅰ in 13 cases(15.3%), grade Ⅱ in 37 cases(43.5%), grade Ⅲ in 25 cases(29.4%), grade Ⅳ in 5 cases(5.9%), and grade V in 3 cases(3.5%). Two patients died of postoperative complications(2.3%). Conclusion Keyhole microscopic craniotomy via lateral fissure in ultra-early stage has the advantages of less trauma, good intraoperative exposure and complete hemostasis, which is especially suitable for patients with moderate bleeding in the basal ganglia, and it can promote the recovery of neurological function in the later stage.

关 键 词：高血压性脑出血 基底节区 显微手术 锁孔小骨窗 超早期 外侧裂 

分 类 号：R743.34[医药卫生—神经病学与精神病学] R651.1[医药卫生—临床医学]