经侧裂-岛叶入路与经皮层入路手术治疗高血压性基底节区出血的疗效  

Efficacy of microsurgery through transsylvian-insulaRand transcortical approaches foRpatients with hypertensive basal ganglia hemorrhage

作　　者：钟波 邹国荣 张冬根 胡友珠 罗庆勇 ZHONG Bo;ZOU Guo-rong;ZHANG Dong-gen;HU You-zhu;LUO Qing-yong(Department of Neurosurgery,Xinyu Hospital Affiliated to Nanchang University,Xinyu 338000,China)

机构地区：[1]新余市人民医院神经外科,江西338000

出　　处：《中国临床神经外科杂志》2024年第5期264-267,共4页Chinese Journal of Clinical Neurosurgery

基　　金：江西省新余市科技计划项目(20223090862)。

摘　　要：目的对比分析经侧裂-岛叶入路和经皮层入路手术治疗高血压基底节区出血的疗效。方法回顾性分析2018年9月至2022年6月手术治疗的86例高血压性基底节区出血的临床资料。36例经侧裂-岛叶入路手术(观察组),50例经皮层入路手术(对照组)。术后24 h内复查CT计算血肿残存率,术后3、12个月采用GOS评分评定预后;术后12个月进行言语功能测定。结果观察组术后24 h血肿残余率(16.7%,6/36)明显低于对照组(44.0%,22/50;P<0.05);观察组术后3、12个月GOS评分[分别为(3.42±0.50)分、(4.24±0.44)分]均明显优于对照组[分别为(3.04±0.40)、(3.78±0.42)分;P<0.05];观察组术后12个月言语功能恢复良好率(84.8%,28/33)明显优于对照组(60.4%,26/43;P<0.05)。结论与皮层入路手术相比,经侧裂-岛叶入路手术清除基底节区出血创伤小,血肿残存率低,言语功能可得到良好保护,能最大限度保护病人神经功能并显著改善病人的预后。Objective To compare the clinical efficacy of surgery through transsylvian-insulaRapproach and transcortical approach foRpatients with hypertensive basal ganglia hemorrhage(HBGH).Methods The clinical data of 86 patients with HBGH underwent surgery from SeptembeR2018 to June 2022 were retrospectively analyzed.Thirty-six patients underwent surgery through transsylvian-insulaRapproach(observation group)and 50 patients underwent surgery through transcortical approach(control group).The rate of hematoma retation was calculated by CT within 24 h afteRsurgery,and the prognosis was assessed by GOS score at 3 and 12 months afteRsurgery.Speech function was tested 12 months afteRoperation.Results The residual rate of hematoma 24 h afteRoperation in the observation group(16.7%,6/36)was significantly loweRthan that(44.0%,22/50)in the control group(P<0.05).The GOS scores of the observation group at 3 and 12 months afteRoperation[(3.42±0.50)points and(4.24±0.44)points,respectively]were significantly betteRthan those[(3.04±0.40)points and(3.78±0.42)points,respectively]of the control group(P<0.05).The rate of good speech function recovery 12 months afteRoperation in the observation group(84.8%,28/33)was significantly higheRthan that(60.4%,26/43)in the control group(P<0.05).Conclusions Compared with surgery through transcortical approach foRpatients with HBGH,surgery through transsylvian-insulaRapproach has less trauma and loweRresidual rate of hematoma,betteRprotection of speech function,maximum protection of neurological function and significant improvement of patient prognosis.

关 键 词：高血压性脑出血 基底节区 显微手术 经侧裂-岛叶入路 经皮层入路 疗效 

分 类 号：R743.34[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]