经外侧裂入路与经颞叶皮质入路在高血压性基底核区脑出血的疗效比较  

To compare the application effect of translateral fissure approach and transtemporal cortical approach in hypertensive basal ganglia hemorrhage

作　　者：刘波 戴冬晴 滕晓华 段答 潘林香 陈静 Liu Bo;Dai Dongqing;Teng Xiaohua;Duan Da;Pan Linxiang;Chen Jing(Department of Neurosurgery,921 Hospital of Joint Logistics Support Force,Changsha,Hunan 410003,China)

机构地区：[1]联勤保障部队921医院神经外科,湖南长沙410003

出　　处：《中国微侵袭神经外科杂志》2023年第12期67-71,共5页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的对比分析经颞叶皮质与经外侧裂入路术治疗高血压性基底核区脑出血(hypertensive basal ganglia hemorrhage,HBGH)的临床价值及对患者病情与预后指标的影响。方法选取84例HBGH患者,采用随机数字表法分为A组(经外侧裂入路手术)与B组(经颞叶皮质入路手术),各42例。比较两组手术指标、磁共振弥散张量成像(diffusion tensor imaging,DTI)参数、Fugl-Meyer运动功能评定量表(Fugl-MeyerAssessment Scale,FMA)评分、γ-干扰素(Interferon-γ,IFN-γ)水平、简易精神状态评价量表(Mini-Mental State Examination,MMSE)评分、T细胞免疫球蛋白黏蛋白分子3(T cell immunoglobulin and mucin-containing molecule 3,TIM-3)水平、生活质量量表(Medical Outcomes Study 36-Item Short-Form Health Survey,SF-36)评分、血肿清除效果及并发症发生情况。结果术前两组TIM-3、FMA、rFA、MMSE、IFN-γ、SF-36差异无统计学意义(P>0.05)。术后3个月,A组TIM-3、IFN-γ水平低于B组,rFA数值与FMA、MMSE、SF-36评分高于B组(P<0.05)。A组手术指标优于B组,血肿清除效果优良率高于B组(85.71%与66.67%),并发症发生率低于B组(9.52%与30.95%)(P<0.05)。结论经外侧裂入路血肿清除的效果与安全性优于经颞叶皮质入路,能够促进患者神经与运动能力恢复,降低颅内再出血等并发症发生风险。Objective To compare and analyze the clinical value of the transtemporal cortical approach and the translateral fissure approach in the treatment of hypertensive basal ganglia hemorrhage(HBGH)and their impact on patients'condition and prognosis.Methods Eighty-four patients diagnosed with HBGH were randomly divided into two groups:Group A(42 cases,treated by the translateral fissure approach)and Group B(42 cases,treated by the transtemporal cortical approach).Surgical parameters,diffusion tensor imaging(DTI)parameters,Fugl-Meyer motor function assessment(FMA)scores,γ-Interferon(IFN-γ)levels,Mini-Mental State Examination(MMSE)scores,T cell immunoglobulin and mucin-containing molecule 3(TIM-3)levels,Medical Outcomes Study 36-Item Short-Form Health Survey(SF-36)scores,hematoma removal effects,and complication rates were compared.Results Prior to surgery,there were no statistically significant differences in TIM-3,FMA,fractional anisotropy(FA),MMSE,IFN-γ,and SF-36 scores between the two groups(P>0.05).Three months after operation,Group A showed lower TIM-3 and IFN-γlevels and higher FA,FMA,MMSE,and SF-36 scores compared to Group B(P<0.05).The operative indexes of Group A were superior to those of Group B,with a higher rate of effective hematoma removal(85.71%vs.66.67%)and a lower incidence of complications(9.52%vs.30.95%)(P<0.05).Conclusion The translateral fissure approach for hematoma removal is more effective and safer than the transtemporal cortical approach,which can promote the recovery of nerve and motor functions in patients,and reduce the risk of complications such as intracranial rebleeding.

关 键 词：脑出血 高血压性 基底核区 血肿清除术 经外侧裂入路 经颞叶皮质入路 

分 类 号：R743[医药卫生—神经病学与精神病学]