颞部直切口小骨窗锁孔开颅手术治疗基底节出血的疗效  

Analysis of the curative effect of temporal straight incision small bone window keyhole craniotomy in the treatment of basal ganglia hemorrhage

作　　者：杨亚飞 吴炳山[1] 高鹏[1] 代兴亮 程宏伟[1] YANG Yafei;WU Bingshan;GAO Peng;DAI Xingliang;CHENG Hongwei(Department of Neurosurgery,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院神经外科,合肥230022

出　　处：《实用医学杂志》2022年第24期3065-3071,共7页The Journal of Practical Medicine

基　　金：国家自然科学基金项目(编号:81702457)。

摘　　要：目的探讨颞部直切口小骨窗锁孔开颅手术治疗基底节出血的疗效。方法回顾性分析安徽医科大学第一附属医院神经外科2018年8月至2022年2月收治的72例行开颅手术的基底节出血患者。其中33例患者行锁孔开颅手术(观察组),39例患者行大骨瓣开颅手术(对照组),比较两者手术效果,包括手术时间、血肿清除比例、术后并发症、住院时长、住院费用,出院时的意识状态及预后情况。结果观察组与对照组对比结果提示,两组开颅时间分别为(17.03±4.60)min和(38.18±8.49)min,手术时间分别为(130.73±44.70)min和(211.10±60.14)min,血肿清除率分别为(92.88±5.33)%和(87.00±15.00)%,住院时间分别为(16.88±8.02)d和(22.79±11.23)d,硬膜外血肿发生比例分别为15.15%和41.03%,颞肌水肿发生比例分别为12.12%和41.03%,住院费用观察组(10.47±4.35)万元,对照组(13.08±5.30)万元,上述指标的差异均有统计学意义(P<0.05)。观察组和对照组的ICU入住时间[(7.91±5.40)d和(9.38±8.34)d]、机械通气时间[(6.06±4.80)d和(6.90±5.64)d]、出院时GCS评分[(12.38±2.62)和(12.03±2.40)]、颅内感染比例(0%和5.13%)、术后肺部感染发生比例(54.55%和51.28%)、术后再出血比例(3.03%和5.13%)和术后深静脉血栓发生比例(12.12%和7.69%),两组效果差异无统计学意义(P>0.05);观察组和对照组术后3月日常活动能力评分(ADH)评估中功能正常比例为6.25%和2.70%、功能轻度损害比例为25.00%和24.32%、功能中度损害比例为34.48%和32.43%、功能重度损害比例为28.13%和32.43%、死亡比例6.25%和8.11%,两组预后差异无统计学意义(P>0.05)。结论颞部直切口小骨窗锁孔开颅治疗基底节出血创伤小,开颅时间短,清除血肿率高,显著缩短手术时间和住院时间,减少并发症,降低住院费用,具有较好的临床疗效,安全性较高,具备临床应用价值。Objective To investigate the effect of temporal straight incision small bone window keyhole craniotomy in the treatment of basal ganglia hemorrhage.Methods A retrospective analysis was performed on 72patients with basal ganglia hemorrhage who underwent craniotomy in the Department of Neurosurgery of the First Affiliated Hospital of Anhui Medical University from August 2018 to February 2022.There were 33 patients who had keyhole craniotomy(observation group)and 39 patients who had large-scale craniotomy(control group).The surgical outcomes of the two groups were compared,including operation time,hematoma clearance ratio,postoperative complications,and hospitalization,duration,hospitalization costs,state of consciousness at discharge,and prognosis.Results The comparison between the observation group and the control group showed that the craniotomy time in the two groups was(17.03±4.60)min and(38.18±8.49)min,respectively,the operation time was(130.73±44.70)min and(211.10±60.14)min,respectively.The clearance rates were(92.88±5.33)% and(87.00±15.00)%,respectively.The length of hospital stay was(16.88±8.02)d and(22.79±11.23)d,respectively.The incidence of epidural hematoma was 15% and 41%,respectively.The incidence of muscle edema was 12% and 41%,respectively.The hospitalization expenses of the observation group were(10.47±4.35)ten thousand yuan,and the control group was(13.08±5.30)ten thousand yuan.The difference of the above indicators was statistically significant(P<0.05).In the observation group and the control group,the ICU stay time was(7.91±5.40)d and(9.38±8.34)d,the mechanical ventilation time was(6.06±4.80)d and(6.90±5.64)d,the GCS score at discharge was(12.38±2.62)and(12.03±2.40),the proportion of intracranial infection 0% and 5%,and the incidence rate of pulmonary infection was 55% and 51%,the incidence rate of postoperative rebleeding was 3% and 5%,and the incidence rate of postoperative deep vein thrombosis was 12% and 8%.There was no significant difference(P>0.05).In the ADH assessment of

关 键 词：基底节出血 锁孔手术 直切口 疗效 

分 类 号：R743.34[医药卫生—神经病学与精神病学]