经颞叶皮质造瘘与经侧裂-岛叶入路手术治疗高血压性基底节区出血的疗效  

Clinical efficacy of micorsurgery for patients with hypertensive basal ganglia hemorrhage:transsylvian-transinsular approach vs.transcortical-transtemporal approach

作　　者：焦伟 张玉磊[1] JIAO Wei;ZHANG Yu-lei(Department of Neurosurgery,Bozhou People's Hospital,Bozhou 236800,China)

机构地区：[1]亳州市人民医院神经外科,安徽236800

出　　处：《中国临床神经外科杂志》2022年第6期461-463,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨经颞叶皮质造瘘与经侧裂-岛叶入路手术治疗高血压性基底节区出血的疗效。方法回顾性分析2019年1月至2019年12月手术治疗的31例高血压性基底节区出血的临床资料。经侧裂-岛叶入路手术17例(观察组),经颞叶皮质造瘘入路手术14例(对照组)。术后3个月采用改良Rankin量表评分评估预后,其中0~2分为预后良好。结果观察组手术时间([122.2±28.5)min]较对照组([154.9±34.5)min]明显缩短(P<0.05)。观察组术后24 h血肿清除率(92.9%±4.5%)较对照组(81.6%±5.9%)显著提高(P<0.05)。观察组术后并发症总发生率(11.8%,2/17)明显低于对照组(50.0%,7/14;P<0.05)。观察组术后3个月预后良好率(82.4%,14/17)明显高于对照组(42.9%,6/14;P<0.05)。结论与经颞叶皮质造瘘手术相比,经侧裂-岛叶入路手术治疗高血压性基底节区出血损伤小、手术时间短、血肿清除率高,疗效更好。Objective To compare the effectiveness of micorsurgery through transsylvian-transinsular approach and transcortical transtemporal approach for the patients with hypertensive basal ganglia hemorrhage(HBGH).Methods The clinical data of 31 patients with HBGH who underwent microsurgery from January 2019 to December 2019 were analyzed retrospectviely.Of 31 patients,17 patients received microsurgery through transsylvian-transinsular approach(obseravation group)and 14 through transcortical-transtemporal approach(control group).The prognosis was assessed using modified Rankin scale(mRS)score 3 months after operation,with a mRS score≤2 as good prognosis.Results The operation time of the observation group[(122.2±28.5)min]was significantly shorter than that[(154.9±34.5)min]of the control group(P<0.05).The hematoma clearance rate(92.9%±4.5%)in the observation group at 24 hours after operation was significantly higher than that(81.6%±5.9%)in the control group(P<0.05).The total incidence of postoperative complications in the observation group(11.8%,2/17)was significantly lower than that(50.0%,7/14)in the control group(P<0.05).The good prognosis rate 3 months after operation in the observation group(82.4%,14/17)was significantly higher than that(42.9%,6/14)in the control group(P<0.05).Conclusions For the patients with HBGH,microsurgery through transsylvian-transinsular approach has less damage,shorter operation time,higher hematoma clearance rate and better curative effect compared with the microsurgery through transcortical-transtemporal approach.

关 键 词：高血压性脑出血 基底节 经皮质造瘘入路 经侧裂-岛叶入路 显微手术 疗效 

分 类 号：R743.34[医药卫生—神经病学与精神病学] R651.12[医药卫生—临床医学]