高血压基底节脑出血两种手术入路血肿清除效果比较

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摘要目的探讨外侧裂-岛叶入路和额中回皮质入路对高血压基底节脑出血(hypertensive basal ganglia hemorrhage,HBGH)患者的血肿清除效果。方法选取2019-10至2022-01在北京昌平医院手术的108例HBGH 患者,按手术方案不同分为两组,每组54例。对照组采用侧裂-岛叶入路血肿清除术,观察组采用额中回入路血肿清除术,对两组患者的手术时间、苏醒时间、血肿清除率及术后3个月格拉斯哥预后评分(Glasgow outcome scale,GOS)进行对比分析。结果观察组血肿清除率为91.63%±0.77%,高于对照组(82.82%±2.62%),差异有统计学意义(P<0.05),且手术时间、术中出血量、手术后并发症发生率、住院时间均显著优于对照组,差异有统计学意义(P<0.05);观察组患者术后3个月的GOS评分显著高于对照组,差异有统计学意义(P<0.05)。结论 HBGH患者采用经额中回入路清除血肿,血肿清除率高,可缩短手术时间,改善患者神经功能预后。

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	孙剑
	洪顺明
	杜海斌
	李建强

关键词 ：额中回入路, 侧裂岛叶入路, 高血压基底节脑出血, 血肿清除术, 微创

Abstract：Objective To compare the hematoma removal effect of trans-sylvian insular approach and ventriculostomy through middle frontal gyrus approach in hypertensive basal ganglia hemorrhage (HBGH) patients.Methods One hundred and eight patients with HBGH treated in Beijing Changping Hospital from October 2019 to January 2022 were divided into two groups according to surgical treatments, with 54 cases underwent trans-sylvian insular approach (control group) and ventriculostomy through middle frontal gyrus approach (observational group), respectively. The operation time (OT), postoperative recovery time (PRT), hematoma clearance rate (HCR), operation-related complication (ORC), and Glasgow Outcome Scale (GOS) 3 months after surgery of the two groups were compared.Results The hematoma clearance rate in the observational group was 91.63%±0.77%, which was significantly higher than that in the control group (82.82%±2.62%) (P<0.05). The cases with operation time, intraoperative bleeding loss, operation-related complication, and hospital staying of the observation group were significantly lower than those of the control group, while GOS 3 months after surgery were significantly higher than that of the control group (P<0.05).Conclusion The ventriculostomy through middle frontal gyrus approach is more convenient than trans-sylvian insular approach in hematoma removal of HBGH patients, especially in shortening operation, reducing postoperative complication, and improving hematoma effect and neurological prognosis.

Key words： ventriculostomy through middle frontal gyrus approach trans-sylvian insular approach hypertensive basal ganglia hemorrhage hematoma evacuation minimally invasive

收稿日期: 2022-03-21

ZTFLH:

R651.1

作者简介: 孙剑,硕士,副主任医师。

引用本文:

孙剑, 洪顺明, 杜海斌, 李建强. 高血压基底节脑出血两种手术入路血肿清除效果比较[J]. 武警医学, 2022, 33(7): 590-593. SUN Jian, HONG Shunming, DU Haibin, LI Jianqiang. Comparison of hematoma removal effect of two approaches in patients with hypertensive basal ganglia hematoma. Med. J. Chin. Peop. Armed Poli. Forc., 2022, 33(7): 590-593.

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http://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 http://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2022/V33/I7/590

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