经侧裂-岛叶入路显微外科手术治疗基底节区高血压脑出血

目的探讨经侧裂-岛叶入路显微外科手术治疗高血压基底节区脑出血的疗效。方法选取48例高血压基底节区脑出血患者，依据术前CT表现分为外侧型组、前部型组、后部型组、混合型组，均行经侧裂-岛叶入路显微外科手术治疗。分析4组的性别、年龄、血肿体积、术前GCS评分、住院时间、术后不良事件发生率、术后6个月生存状态的异同。结果术后血肿清除〉90％者42例，血肿清除在80％～90％者6例。术后死亡6例，再出血1例。存活的42例中，术后6个月ADL评级Ⅰ级者6例，Ⅱ级者10例，Ⅲ级者17例，Ⅳ级者5例，V级者4例。在术前GCS评分及血肿体积方面，混合型与外侧型、混合型与前部型、后部型与外侧型有显著性差异。结论经侧裂-岛叶入路显微外科手术是治疗基底节区高血压脑出血的理想方法之一。术前血肿的CT分型对基底节区高血压脑出血的治疗和预后判断有-定的指导意义。

Microsurgical operation through lateral fissure - insula lobe approach in treatment of hypertensive cerebral hemorr hage in basal ganglia

Objective It is to approach the effect of microsurgical operation through lateral fissure-insula lobe approach in treatment of hypertensive cerebral hemorrhage in basal ganglia. Methods 48 patients with hypertensive cerebral hemorrhage in basal ganglia were selected and divided into lateral type, anterior type, posterior type and mixed type according to the location of hematomas on CT scans. All patients were underwent microsurgical operation through lateral fissure-insula lobe approach. The gender, age, hematoma volume, the preoperative GCS score, the incidence of postoperative adverse events and the post- operative activity of daily living in sixth month in the four types were analyzed. Results The postoperative CT scans showed that 42 cases were removed the hematomas for more than 90% , while 6 cases between 80% and 90%. g2 patients survived and 6 patients died after operation. The number from activity of daily living （ADL） scale level I to level V were 6 cases, 10 cases, 17 cases, 5 cases and 4 cases respectively. There were significant differences between the mixed type and the lateral type, the mixed type and the anterior type, the posterior type and the lateral type. Conclusion microsurgical operation through lateral fissure-insula lobe approach is an effective treatment for hypertensive cerebral hemorrhage in basal ganglia. The new classification according to CT scans will be helpful for predicting patients＇ prognosis and managing hypertensive cerebral hemorrhage in basal ganglia.