摘要
目的:比较经外侧裂入路与颞叶皮层入路显微手术治疗基底节区高血压脑出血的疗效及安全性。方法:根据治疗方式将80例基底节区高血压脑出血患者分为经颞叶皮层入路显微手术(对照组,n=37)及经外侧裂入路显微手术组(观察组,n=43)。比较两组患者手术时间及术后24 h患者血肿清除情况;术前、术后3 d、7 d、30 d,采用格拉斯哥昏迷量表(GCS)评估两组患者意识障碍程度;术后6个月,分别采用格拉斯哥预后评分(GOS)、日常生活活动能力(ADL)量表评估两组患者的预后情况及生活能力,记录并比较两组患者术后并发症发生情况。结果:观察组患者手术时间较对照组延长,但组间差异无统计学意义(P>0.05);观察组患者血肿清除率优于对照组(Z=-2.054,P=0.040)。术后3 d、7 d、30 d,观察组患者GCS评分均高于对照组(t=2.780、3.192、3.221,P=0.007、0.002、0.002)。术后6个月,观察组患者GOS分级优于对照组(Z=-2.250,P=0.024),ADL分级优于对照组(Z=-2.382,P=0.017)。术后,两组患者颅内感染、肺部感染、二次出血、消化道出血、脑梗死等并发症发生率比较,差异无统计学意义(P>0.05)。结论:与经颞叶皮层入路相比,经外侧裂入路显微手术可有效提高基底节区高血压脑出血患者的血肿清除率,促进患者意识及日常生活能力恢复,且不增加术后并发症发生风险。
Objective:To compare the efficacy and safety of lateral fissure approach and temporal cortex approach microsurgery in the treatment of hypertensive intracerebral hemorrhage in basal ganglia region.Methods:80 patients with hypertensive intracerebral hemorrhage in basal ganglia region were selected as the research objects.According to the treatment methods,they were divided into two groups:temporal cortex approach microsurgery group(control group,n=37)and lateral fissure approach microsurgery group(observation group,n=43).The operation time and hematoma clearance 24 hours after operation were compared between the two groups.Before operation,3 d,7 d and 30 d after operation,glasgow coma scale(GCS)was used to evaluate the degree of consciousness disorder of the two groups.After 6 months,glasgow outcome score(GOS)and activity of daily living(ADL)scale were used to evaluate the prognosis and activity of daily living of the two groups.The postoperative complications of the two groups were recorded and compared.Results:The operation time of the observation group was longer than that of the control group,but there was no significant difference between the two groups(P>0.05).The hematoma clearance rate of the observation group was better than that of the control group(Z=-2.054,P=0.040).The GCS scores of the observation group were higher than those of the control group 3 d,7 d and 30 d after operation(t=2.780,3.192,3.221,P=0.007,0.002,0.002).6 months after operation,GOS grade of observation group was better than that of control group(Z=-2.250,P=0.024),ADL grade of observation group was better than that of control group(Z=-2.382,P=0.017).After operation,there was no significant difference in the incidence of intracranial infection,pulmonary infection,secondary hemorrhage,gastrointestinal hemorrhage,cerebral infarction and other complications between the two groups(P>0.05).Conclusion:Compared with temporal cortex approach,microsurgery via lateral fissure approach can effectively improve the hematoma clearance rate of patients with hypertensive intracerebral hemorrhage in basal ganglia region,promote the recovery of patients consciousness and activities of daily living,and do not increase the risk of postoperative complications.
作者
汤军
夏涛
TANG Jun;XIA Tao(Department of Neurosurgery,the Third People's Hospital of Hubei Province,Zhongshan Hospital of Hubei Province,Wuhan 430030,Hubei,China;Department of Anesthesiology,the Third People's Hospital of Hubei Province,Zhongshan Hospital of Hubei Province,Wuhan 430030,Hubei,China)
出处
《川北医学院学报》
CAS
2021年第5期640-643,共4页
Journal of North Sichuan Medical College
关键词
高血压脑出血
基底节区
经外侧裂入路
经颞叶皮层入路
显微血肿清除术
Hypertensive intracerebral hemorrhage
Basal ganglia region
Lateral fissure approach
Temporal cortex approach
Microsurgery
