超早期经侧裂-岛叶入路显微外科治疗高血压基底节区脑出血56例临床分析

目的探讨超早期小骨窗经侧裂-岛叶入路微创治疗高血压基底节区脑出血的临床价值。方法选取56例高血压基底节区脑出血患者,根据CT定位按微创手术设计切口,解剖外侧裂后经岛叶皮层显微镜下清除血肿并进行回顾性分析,全部手术均在6小时内进行。结果 56例高血压基底节区脑出血病人中,平均手术时间为1小时,术后24h内头颅CT复查,血肿清除达90%以上者41例,80%～90%的13例,70%～80%的2例,其中1例术后再出血;术后6个月随访,死亡2例,死亡率3.57%,存活患者术后6个月时ADL评分:I～Ⅱ级21例(37.50%),Ⅲ级19例(33.93%),IV级11例(19.64%),V级(植物生存)3例(5.35%),恢复良好率(ADL I～Ⅲ级)达71.43%。结论采用超早期经侧裂-岛叶入路微创治疗高血压基底节区脑出血,通过大脑自然沟裂进入血肿腔,使脑组织损伤降至最低,有利于清除血肿,抢救处于缺血半暗带尚有一定功能的脑组织,手术时间短,对内环境干扰小,恢复快,能降低病死率和病残率,改善生存质量,有较好的临床应用价值。

Super early lateral fissure-insular approach for Microsurgical treatment of basal hypertensive ganglia hemorrhage clinical analysis of 56 cases

Objective Study of microsurgery through lateral fissure approach of minimally invasive treatment of hypertensive basal ganglia hemorrhage clinical value.Methods Methods 56 cases of basal hypertensive ganglia hemorrhage of patients,according to the CT positioning by minimally invasive incision operation design,anatomy of the lateral fissure after the insular cortex under microscope with removal of the hematoma were analyzed retrospectively,all operation were performed within 6 hours.Results 56 cases of basal hypertensive ganglia hemorrhage of patients,the mean operation time was 1 hours,within 24h after operation on cranial CT review,evacuation of more than 90% in 41 cases,13 cases of 80%~90%,70%~80% of the 2 patients,including 1 cases of postoperative hemorrhage;after 6 months follow-up,2 patients died,3.57% mortality,survival of patients after 6 months ADL score: I ~Ⅱ in 21 cases(37.50%),19 cases in grade Ⅲ(33.93%),Ⅳ in 11 cases(19.64%),Ⅴ(vegetable) in 3 cases(5.35%),good recovery rate(ADL I~Ⅲup to 71.43% class).Conclusion Ultra early through lateral fissure approach of minimally invasive treatment of basal hypertensive ganglia hemorrhage,brain via natural fissure into the hematoma cavity,so that brain tissue damage to the lowest,facilitates the removal of the hematoma,rescue in the ischemic penumbra is the functional organization of the brain,short operation time,internal environmental interference,fast recovery,can reduce the mortality rate and disability rate,improve the quality of life,have a good clinical value.