高血压性基底节区脑出血的CT分型及手术策略

发布时间：2018-03-01 14:37

本文关键词： 高血压脑出血基底节影像学分型经侧裂-脑岛入路经颞上沟-脑岛入路　出处：《中国现代医学杂志》2017年03期 　论文类型：期刊论文

【摘要】：目的探讨高血压性基底节区脑出血的CT分型、手术方式及疗效。方法 60例高血压性基底节区脑出血患者,根据CT影像中侧裂前点与血肿主体的关系,将基底节区出血分为3个类型及2个亚型:1侧裂型;2侧裂后部型:跨侧裂-后部型和侧裂后部型;3长轴型。对不同分型患者分别选择经侧裂-脑岛入路或经颞上沟-脑岛入路,并总结手术技术要点,评价疗效。结果 60例患者侧裂型占10.0%(6例);跨侧裂后部型占48.3%(29例);侧裂后部型占26.7%(16例);长轴型占15.0%(9例)。采用经侧裂-脑岛入路清除血肿占56.7%(34例),经颞上沟-脑岛入路占43.3%(26例)。术后复查头颅CT,56例血肿清除90%,4例血肿清除75%,平均住院天数16.5 d。根据格拉斯哥昏迷评分法评分:恢复良好13例,中度残疾31例,重度残疾13例,植物生存2例,死亡1例。结论该分型方法对手术入路选择具有指导意义,经侧裂-脑岛入路和经颞上沟-脑岛入路清除基底节区脑出血,具有微创、高血肿清除率、低术后再出血率、神经功能恢复良好等优点。
[Abstract]:Objective to study the CT classification, surgical method and curative effect of hypertensive basal ganglia hemorrhage. Methods 60 patients with hypertensive basal ganglia hemorrhage were studied according to the relationship between the anterior point of lateral fissure and the main body of hematoma. The hemorrhage in basal ganglia was divided into three types and two subtypes: translateral fissure and posterior fissure: translateral fission-posterior and posterior lateral fissure. The patients with different types of hemorrhage were divided into translateral fissure and cerebral island approach or superior temporal sulcus and cerebral island approach, respectively. The main points of surgical techniques are summarized. Results 60 cases had lateral fissure type (10.0%), 29 cases had translateral fissure type (48.3 cases), 16 cases had lateral fissure type (26.7 cases), 9 cases had long axis type (15.0%), 56.734 cases had hematoma removed via lateral fissure and cerebral island approach, and 56.734 cases had hematoma removed via superior temporal sulcus and cerebral island. After operation, 56 cases of head CTU with hematoma clearance, 90 cases with hematoma clearance and 4 cases with hematoma clearance were performed. The average hospitalization days were 16.5 days. According to Glasgow coma score, 13 cases recovered well. There were 31 cases of moderate disability, 13 cases of severe disability, 2 cases of vegetative survival and 1 case of death. It has the advantages of minimally invasive, high hematoma clearance rate, low postoperative rebleeding rate and good recovery of nerve function.
【作者单位】：南通大学附属建湖医院神经外科;苏州大学附属第一人民医院神经外科;
【基金】：江苏省医改试点单位科研课题(No:YG201512)
【分类号】：R651.1;R544.1

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