经外侧裂岛叶入路与经颞叶皮质入路治疗基底核区血肿的疗效分析  

Analysis of the efficacy of transsylvian insular approach and transtemporal cortical approach in the treatment of basal ganglia hemorrhage

作　　者：杨冬旭[1] 郭强[1] 王斐[1] 张晓红[2] 陈亚男 卢浩 李雪源 朱治 Yang Dongxu;Guo Qiang;Wang Fei;Zhang Xiaohong;Chen Yanan;Lu Hao;Li Xueyuan;Zhu Zhi(Department of Emergency Stroke,the Affiliated Hospital of Jining Medical University,Jining 272007,China;Department of Medical Laboratory Science,the Affiliated Hospital of Jining Medical University,Jining 272007,China)

机构地区：[1]济宁医学院附属医院急诊卒中科,济宁272007 [2]济宁医学院附属医院检验科,济宁272007

出　　处：《中华神经外科杂志》2024年第4期397-401,共5页Chinese Journal of Neurosurgery

基　　金：济宁医学院附属医院博士基金(2022-BS-13)。

摘　　要：目的对比分析采用经外侧裂岛叶入路与经题叶皮质入路治疗基底核区出血的临床疗效。方法回顾性分析2018年9月至2022年12月济宁医学院附属医院急诊卒中科采用开颅手术治疗的152例基底核区出血患者的临床资料。根据手术入路的不同,将患者分为经外侧裂岛叶入路组(简称侧裂入路组,74例)与经叶皮质入路组(简称皮质入路组,78例)。比较两组的手术时长、骨瓣回纳比率、血肿清除率、术后再出血情况。术后3个月,对比分析两组左侧脑出血患者的语言功能情况。术后6个月,应用改良Rankin量表评分(mRS)评估患者的预后情况,mRS≤2分为预后良好,>2分为预后不良。结果侧裂入路组的骨瓣回纳比率、血肿清除率分别为73.0%(54例)、(94.3±5.5)%,与皮质入路组的50.0%(39例)、(86.9±14.1)%比较,差异均有统计学意义(均P<0.01);两组的手术时长、再出血率的差异均无统计学意义(均P>0.05)。术后3个月随访,侧裂人路组34例左侧出血的患者中,构音障碍、失语的比率分别为35.3%(12例)、5.9%(2例);皮质入路组36例左侧出血的患者中,构音障碍、失语的比率分别为44.4%(16例)、30.6%(11例),差异有统计学意义(P=0.004)。术后6个月,侧裂入路组的预后良好率为21.6%(16/74),预后不良率为78.4%(58/74);皮质入路组的预后良好率为5.1%(4/78),预后不良率为94.1%(74/78),两组患者的预后比较差异有统计学意义(P=0.003)。结论与经叶皮质入路比较,采用经外侧裂岛叶入路开颅手术治疗基底核区出血的创伤小、术后并发症的发生率低、预后相对好。Objective To compare the clinical efficacy of transsylvian insular approach and transtemporal cortical approach in the treatment of basal ganglia hemorrhage.Methods The clinical data of 152 patients with basal ganglia hemorrhage who underwent craniotomy in Department of Emergeroy Stroke,the Affiliated Hospital of Jining Medical University from September 2018 to December 2022 were retrospectively analyzed.The patients were divided into transsylvian insular approach group(sylvian approach group,74 cases)and transtemporal cortical approach group(cortical approach group,78 cases)according to different surgical approaches.The operation time,The ratio of bone flap return,hematoma clearance rate,and postoperative rebleeding were compared between the two groups.Three months after operation,the language function of the two groups of patients with left cerebral hemorrhage was compared and analyzed.At 6 months after operation,the modified Rankin scale(mRS)score was used to evaluate the outcomes of the patients.The mRS≤2 was defined as good outcome,and mRS>2 was defined as poor outcome.Results The ratio of bone flap return and hematoma clearance rate of the sylvian fissure approach group were 73.0%(54 cases)and(94.3±5.5)%,respectively,which were significantly different from those[50.0%(39 cases)and(86.9±14.1)%]of the cortical approach group(both P<0.01).There were no significant differences in operation time or rebleeding rate between the two groups(both P>0.05).At 3-month follow-up,among 34 patients with left basal ganglia hemorrhage in sylvian approach group,the rates of dysarthria and aphasia were 35.3%(12 cases)and 5.9%(2 cases)respectively.Of the 36 patients in the cortical approach group,the rates of dysarthria and aphasia were 44.4%(16 cases)and 30.6%(11 cases)respectively,and the inter-group differences were statistically significant(P=0.004).At 6 months after operation,21.6%(16/74)of the patients in the sylvian approach group had good outcome and 78.4%(58/74)had poor outcome.In the cortical approach group,5.1%(4

关 键 词：脑血管基底神经节出血 神经外科手术 治疗结果 经外侧裂岛叶入路 经叶皮质入路 

分 类 号：R651.1[医药卫生—外科学]