摘要
目的探讨经外侧裂入路和经颞叶入路小骨窗显微手术治疗高血压基底节区脑出血的临床效果。方法选择82例高血压基底节区脑出血患者,其中男性54例,女性28例;年龄38~74岁,平均年龄58.5岁。按照随机数字表法分为外侧裂组和颞叶组,每组41例。两组均接受小骨窗显微手术治疗,外侧裂组经外侧裂入路,颞叶组经颞叶皮质入路。比较两组手术时间、术中出血量、术后意识恢复时间、血肿清除率、并发症发生率,并比较两组术后1、3、7 d格拉斯哥昏迷量表(GCS)评分,比较两组术前及术后5 d血清细胞角蛋白-18裂解片段(CCCK-18)、D-二聚体(D-D)水平;两组随访6个月,比较两组预后良好率。结果两组手术时间、术中出血量和术后意识恢复时间,差异均无统计学意义(P>0.05);外侧裂组血肿清除率高于颞叶组(95.12%vs 75.61%,P<0.05);并发症发生率低于颞叶组(9.76%vs 36.59%;P<0.05);术后1、3、7 d GCS评分均高于颞叶组[(9.04±0.90)分vs(8.32±0.85)分、(9.95±1.12)分vs(9.11±0.89)分、(12.33±1.22)分vs(10.52±1.14)分;P<0.01];术后5 d血清CCCK-18、D-D水平外侧裂组低于颞叶组[CCCK-18:(182.61±25.77)U/L vs(212.58±29.40)U/L;D-D:(1.77±0.41)mg/L vs(2.31±0.53)mg/L;P<0.01];术后6个月预后良好率外侧裂组高于颞叶组(70.00%vs 41.03%;P<0.05)。结论经外侧裂入路可提高血肿清除率,减轻脑组织损伤,并发症少,有利于患者神志的恢复和预后的改善,可作为高血压基底节区脑出血小骨窗显微手术优选的入路方式。
Objective To investigate the clinical effect of microsurgical treatment of hypertensive basal ganglia intracerebral hemorrhage by small window craniotomy via lateral fissure and temporal lobe approach.Methods A total of 82 patients with hypertensive basal ganglia intracerebral hemorrhage were enrolled,which included 54 males and 28 females,aged 38-74 years old with mean age of 58.5 years old.All of them were divided into lateral fissure group(n=41,performed small window craniotomy via lateral fissure)and temporal lobe group(n=41,performed small window craniotomy via temporal lobe)according to random number table method.The operation time,intraoperative bleeding,postoperative consciousness recovery time,hematoma clearance rate,and complication rate were compared between 2 groups.The Glasgow coma scale(GCS)score at 1-day,3-day,and 7-day after operation,and serum cytokeratin-18 cleavage fragment(CCCK-18)and D-dimer(D-D)levels before and 5-day after operation were compared between 2 groups.Follow up for 6-month to compare the good prognosis rate between 2 groups.Results There were no statistically significant differences in operative time,intraoperative bleeding and postoperative consciousness recovery time between 2 groups(P>0.05).The hematoma clearance rate in lateral fissure group was higher than that in temporal lobe group(95.12%vs 75.61%;P<0.05);the complication rate was lower than that in temporal lobe group(9.76%vs 36.59%;P<0.05).The GCS scores at 1-day,3-day and 7-day after operation were higher than those in temporal lobe group[(9.04±0.90)scores vs(8.32±0.85)scores,(9.95±1.12)scores vs(9.11±0.89)scores,(12.33±1.22)scores vs(10.52±1.14)scores;P<0.01];The serum levels at 5-day after operation of CCCK-18[(182.61±25.77)U/L vs(212.58±29.40)U/L]and D-D[(1.77±0.41)mg/L vs(2.31±0.53)mg/L;P<0.01]in lateral fissure group were lower than those in temporal lobe group.The good prognosis rate at 6-month after operation in lateral fissure group was higher than that in temporal lobe group(70.00%vs 41.03%;P<0.05).Conclusion It is demonstrated that the microsurgery via lateral fissure approach could improve hematoma clearance rate,reduce brain tissue damage and complications,which is beneficial to recovery and prognosis.It can be used as the preferred approach for small window craniotomy of hypertensive basal ganglia cerebral hemorrhage.
作者
刘成辉
梁世行
付剑
於新军
LIU Cheng-hui;LIANG Shi-xing;FU Jian;YU Xin-jun(Department of Neurosurgery,Nanhai District People’s Hospital,Foshan 528200,Guangdong,China)
出处
《生物医学工程与临床》
CAS
2021年第6期709-714,共6页
Biomedical Engineering and Clinical Medicine
关键词
高血压基底节区脑出血
小骨窗
颅内血肿清除术
颞叶
外侧裂
hypertensive basal ganglia cerebral hemorrhage
small bone window
evacuation intracranial hematoma
temporal lobe
lateral fissure
