显微镜下经外侧裂-岛叶入路手术治疗高血压基底核区脑出血的疗效研究  

Study on the Curative Effect of Intracerebral Hemorrhage in the Basal Ganglia Region of Hypertensive Patients Treated by Transsylvian Fissureinsular Approach under Microscope

作　　者：武明明 尤占彪 武曰才 高海军 王赵辉 WU Mingming;YOU Zhanbiao;WU Yuecai;GAO Haijun;WANG Zhaohui(Department of Neurosurgery,Fenyang Hospital of Shanxi Province,Fenyang,Shanxi Province,032200 China)

机构地区：[1]山西省汾阳医院神经外科,山西汾阳032200

出　　处：《中外医疗》2023年第15期43-47,共5页China & Foreign Medical Treatment

基　　金：吕梁市重点研发项目计划任务书(2021SHFZ-2-57)。

摘　　要：目的探讨显微镜下经外侧裂-岛叶入路手术治疗基底核区高血压脑出血(hypertensive intracerebral hemorrhage,HICH)的疗效。方法方便选取2021年9月—2022年11月山西省汾阳医院神经外科诊治的基底核区HICH患者346例为研究对象,随机分成常规组和研究组,每组173例,常规组行传统经颞叶皮层入路手术,研究组在显微镜下行经侧裂-岛叶入路手术。比较两组血肿清除情况、血肿体积、CRRCAE评分、BI评分及并发症发生情况。结果研究组血肿清除率92.49%高于常规组的82.08%,差异有统计学意义(χ^(2)=8.436,P<0.05)。脑水肿体积的组间、组内及交互作用比较,差异有统计学意义(P<0.05);术后3、7 d两组脑水肿体积较术前均降低,且研究组低于常规组,差异有统计学意义(P<0.05)。CRRCAE、BI评分的组间、组内及交互作用比较,差异有统计学意义(P<0.05);两组术后3、6个月的CRRCAE、BI评分均较术前升高,且研究组高于常规组,差异有统计学意义(P<0.05)。研究组并发症总发生率8.09%低于对照组的24.28%,差异有统计学意义(P<0.05)。结论显微镜下经外侧裂-岛叶入路手术治疗基底核区HICH患者,可有效提高血肿清除率,降低脑水肿体积,促进语言功能恢复,改善预后,减少颅内再出血和术后并发症。Objective To explore the therapeutic effect of microsurgery via the lateral fissure insular approach for hypertensive intracerebral hemorrhage(HICH)in the basal ganglia region.Methods 346 patients with HICH in the basal ganglia area diagnosed and treated by neurosurgery of Fenyang Hospital of Shanxi Province from September 2021 to November 2022 were conveniently selected as the study subjects,and were randomly divided into the conventional group and the study group,with 173 cases in each group.The conventional group underwent the traditional temporal cortex approach surgery,and the study group underwent the lateral fissure insular approach surgery under the microscope.Compared the clearance of hematoma,hematoma volume,CRRCAE score,BI score,and incidence of complications between the two groups.Results The hematoma clearance rate of 92.49%in the study group was higher than 82.08%in the conventional group,the difference was statistically significant(χ^(2)=8.436,P<0.05).The differences in brain edema volume between groups,within groups,and among interactions were statistically significant(P<0.05).On the 3rd and 7th day after surgery,the volume of brain edema in both groups decreased compared to before surgery,and the study group was lower than the conventional group,the difference was statistically significant(P<0.05).The differences in inter group,intra group,and interaction effects between CRRCAE and BI scores were statistically significant(P<0.05).The CRRCAE and BI scores of the two groups at 3 and 6 months after surgery were higher than before,and the study group was higher than the conventional group,the difference was statistically significant(P<0.05).The total incidence of complications in the study group was 8.09%lower than that in the control group,which was 24.28%,the difference was statistically significant(P<0.05).Conclusion Microscopic surgery by transsylvian fissureinsula approach for HICH patients in the basal ganglia can effectively improve the clearance rate of hematoma,reduce the volume of brain ed

关 键 词：显微镜 经外侧裂-岛叶入路 基底核区 高血压脑出血 

分 类 号：R5[医药卫生—内科学]