小骨窗开颅经外侧裂入路显微手术治疗高血压性基底节区脑出 血

目的 探讨小骨窗开颅经外侧裂人路显微手术治疗高血压性基底节区脑出血的临床疗效.方法 选取高血压性基底节区脑出血患者96例,其中右侧基底节区出血54例,左侧基底节区出血42例,采取小骨窗开颅,显微镜下经外侧裂入路,清除血肿.结果 96例患者均于术后24 h内行头部CT检查,其中血肿完全清除46例,血肿清除量：＞90％36例,50％～90％10例;再出血4例.术后随访6个月,按格拉斯格预后评分标准：5分12例（12.5％）,4分29例（30.2％）,3分39例（40.6％）,2分8例（8.3％）,1分8例（8.3％）,肺部感染6例和循环功能衰竭2例）,总有效率为83.3％（80/96）.结论 小骨窗开颅经外侧裂入路显微手术治疗高血压性基底节区脑出血,具有手术创伤小、术中清除血肿彻底、并发症和致残率低及功能恢复快等优点,值得临床应用.

Microsurgical Treatment of Hypertensive Basal Ganglia Hemorrhage through Lateral Fissure Small Bone Window Craniotomy Approach

Objective To explore the clinical effect bone window craniotomy approach on hypertensive basal of m icrosurgery through lateral fissure small ganglia hemorrhage. Methods Among the 96 patients,the small bone window craniotomy was performed and the hematoma was removed through lateral fissure approach under microscope in 54 patients with hypertensive hemorrhage in the right basal ganglia and 42 patients with hypertensive hemorrhage in the left basal ganglia. Results Patients underwent head CT examination within 24 hours after operation. Among the 96 patients, hematomas were completely removed in 46, more than 90% of the hematomas were removed in 36,50%-90% of the hematomas were removed in 10,and rehemorrhage occurred in 4. After 6 months of follow-up, outcomes were determined using the Glasgow Outcome Scale （GOS）. Among the 96 patients, GOS 5 was achieved in 12（12.5%）,GOS 4 in 29（30.2%）,GOS 3 in 39（40.6%）,GOS 2 in 8（8.3%）,and GOS 1 in 8 （8.3%, 6 patients with lung infection and 2 patients with circulation failure）. The total effective rate was 83.3% （80/96）. Conclusion Microsurgical treatment of hypertensive basal ganglia hemorrhage through lateral fissure small bone window craniotomy approach has the advantages of minimal invasion, complete hematoma removal, low complication and disability rates,and rapid recovery. Therefore,it is worthy of clinical application.