小骨窗经外侧裂微创术与立体定向微创术对基底节脑出血的疗效比较

发布时间：2018-11-10 19:45

【摘要】：目的探讨小骨窗经外侧裂-岛叶入路显微手术与立体定向穿刺引流术治疗基底节区脑出血患者的临床疗效。方法选择2012-2015年在某医院被诊断为基底节区脑出血的患者110例,信封法随机分为显微组与引流组,各55例。显微组手术方法由同侧翼点入路,经外侧裂-岛叶进入基底节区清理血肿;引流组采用穿刺定位后置管引流颅内血肿。对比分析两组患者神经功能缺损程度、临床指标、血清学指标的差异。结果治疗后,显微组患者术后7 d和21 d SNSS量表评分、术后30 d GOS评分及术后3个月Barthel生活能力指数评分均明显高于引流组,手术时间、术中引流(出血)量、脑血肿体积变化率、术后3 d和5 d脑水肿体积变化率较引流组明显增加,再出血发生率、血肿残留率、卒中相关性肺炎发生率、引流管置管时间明显低于引流组,术后血清CRP、IL-6水平上升幅度小于引流组,差异均有显著性(P0.05,P0.01)。结论小骨窗经外侧裂-岛叶入路显微手术可以有效清除基底节区脑内血肿,降低患者血清学炎性反应水平以及氧化应激反应程度,减轻出血区周围脑组织水肿程度,改善临床神经功能缺损程度评分,临床疗效较好。
[Abstract]:Objective to investigate the clinical effect of microsurgery and stereotactic puncture and drainage through lateral fissure-insular approach in the treatment of intracerebral hemorrhage in basal ganglia. Methods 110 patients diagnosed as basal ganglia intracerebral hemorrhage in a hospital from 2012 to 2015 were randomly divided into microscopic group (55 cases) and drainage group (55 cases). In the microsurgery group, the hematoma was removed from the lateral fissure to the basal ganglia through the lateral fissure through the same flanking point approach, and the drainage group was treated with a puncture and a posterior tube to drain the intracranial hematoma. The degree of nerve function defect, clinical index and serological index were compared between the two groups. Results after treatment, the scores of SNSS scale on 7 and 21 days after operation, GOS scores on 30 days after operation and Barthel life ability index at 3 months after operation in the microscopic group were significantly higher than those in the drainage group, the operative time and the volume of drainage (bleeding) during the operation. The volume change rate of cerebral hematoma and the volume change rate of cerebral edema on the 3rd and 5th day after operation were significantly higher than those in the drainage group. The incidence of rebleeding, the residual rate of hematoma, the incidence of stroke associated pneumonia and the time of drainage tube placement were significantly lower in the drainage group than in the drainage group. The level of serum CRP,IL-6 in the drainage group was significantly higher than that in the drainage group (P 0.05 P 0.01). Conclusion the microsurgery via the lateral fission-insular approach can effectively remove intracerebral hematoma in the basal ganglia, reduce the level of serological inflammatory reaction and oxidative stress reaction, and reduce the degree of edema in the brain tissue around the bleeding area. The clinical curative effect is better by improving the grade of clinical nerve function defect.
【作者单位】：磁县人民医院;
【分类号】：R651.1

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