摘要
目的比较经颞上回-岛叶入路与经侧裂-岛叶入路手术方式治疗高血压性基底节区出血的手术效果。方法120例高血压性基底节区出血手术患者分为两组,每组60例。A组经颞上回-岛叶入路手术,B组采用经侧裂-岛叶入路。比较两组患者病情和手术相关资料。结果两组患者术后6个月GOS评分无统计学差异(P>0.05)。A组恢复良好13例,中度残疾20例,重度残疾11例,植物生存11例,死亡5例;B组恢复良好14例,中度残疾20例,重度残疾10例,植物生存10例,死亡6例。两组血肿清除、责任动脉发现、复发出血及去骨瓣减压率等差异无统计学意义(P>0.05)。A组手术时间短于B组(P<0.05)。结论两种手术入路治疗高血压性基底节区出血效果相仿。建议首选经侧裂-岛叶入路,该入路是经过自然裂隙,对脑组织破坏相对小;但对侧裂分离困难的患者可选择经颞上回-岛叶入路,尤其对不熟练的术者,该入路可避开复杂的侧裂血管,学习曲线更短。
Objective To compare the efficacy of surgery via superior temporal gyrus-insular approach and via lateral fissure-insular approach in the treatment of hypertensive basal ganglia hemorrhage.Methods A total of 120patients with hypertensive basal ganglia hemorrhage were divided into two groups with 60cases each.The surgery was performed via superior temporal gyrusinsular approach(group A)or via lateral fissure-insular approach(group B).The patient condition and surgery-related data were compared between the two groups.Results The postoperative outcomes evaluated by GOS score in the two groups 6 months after surgery were similar(P>0.05).The patients in group A were with good recovery in 13cases,with mode rate disability in 20cases,with severe disability in 11cases,in the vegetative state in 11cases and with death in 5cases.The patients in group B were with good recovery in 14cases,with moderate disability in 20cases,with severe disability in 10cases,in the vegetative state in 10cases and with death in 6cases.There were no statistical differences in hematoma clearance rate,offending artery exposure rate,recurrence rate and decompressive craniectomy rate between the two groups(P>0.05).The operative time was shorter in group A than that in group B(P<0.05).Conclusion The outcomes of the surgery for hypertensive basal ganglia hemorrhage via the two approaches are similar.It is suggested that the lateral fissureinsular approach hemorrhage is better with relatively small damage to the brain tissues.However,for the patients with lateral fissure difficult to separate,via superior temporal gyrus-insular approach can avoid complex lateral cleft blood vessels,especially for unskilled surgeons,and have a shorter learning curve.
作者
陆瑨
徐勤义
毛芳芳
王栋
刘俊
孙呈国
陆俊杰
LU Jin;XU Qinyi;MAO Fangfang(Department of Neurosurgery,People's Hospital of Wuxi Huishan District,Wuxi 214187,CHINA)
出处
《江苏医药》
CAS
2022年第7期703-707,共5页
Jiangsu Medical Journal
基金
无锡市卫生与健康委员会面上资助课题(M202005)。
关键词
高血压
基底节区出血
手术入路
Hypertension
Basal ganglia hemorrhage
Operative approach
