比较三种不同手术方式对基底节脑出血患者长期神经功能及颅内感染的影响

目的探讨小骨窗手术、翼点入路经侧裂显微手术血肿清除+去骨瓣减压术及穿刺引流术对基底节脑出血患者长期神经功能及颅内感染的影响。方法将87例基底节脑出血患者按照随机数字表的顺序分为小骨窗显微血肿清除术组(A组)、穿刺引流术组(B组)及翼点入路经侧裂显微手术血肿清除+去骨瓣减压手术(C组),分析三组患者长期神经功能、颅内感染情况。结果 B组GOS评分显著高于A组(t值5.14,6.33,P0.05)。B组、C组血肿清除率显著高于A组(t=7.90,P0.05)。B组、C组改良Rankin评分、Barthel评分显著高于A组(t=2.69、3.01、3.47、5.52,P0.05)。各组颅内感染率无显著性差异(P0.05)。结论穿刺引流术、翼点入路经侧裂显微手术血肿清除+去骨瓣减压术治疗基底节脑出血的长期神经功能改善方面优于小骨窗微创手术,但术后颅内感染率无显著性差异。

Effects of three different surgical procedures on long-term neurological function and intracranial infection in patients with basal ganglia hemorrhage: a comparative study

Objective To investigate the effects of small bone window craniotomy, hematoma evacuation via the pterional-transsylvian approach combined with decompressive craniectomy, and percutaneous drainage on the long-term neurological function and intracranial infection in patients with basal ganglia hemorrhage.Methods A total of 87 patients with basal ganglia hemorrhage were randomly divided into small bone window craniotomy group (group A), percutaneous drainage group (group B), and hematoma evacuation via the pterional-transsylvian approach combined with decompressive craniectomy group (group C) using a random number table. The long-term neurological function and intracranial infection were analyzed and compared between the three groups.Results Group B had a significantly higher Glasgow Outcome Scale score than group A (t=5.14 and 6.33, P<0.05). Group B and group C had a significantly higher hematoma evacuation rate than group A (t=7.90, P<0.05). And they also had significantly higher modified Rankin score and Barthel score than group A (t=2.69, 3.01, 3.47, and 5.52, P<0.05). There was no significant difference in intracranial infection rate between the three groups (P>0.05).Conclusions For the treatment of basal ganglia hemorrhage, percutaneous drainage and hematoma evacuation via the pterional-transsylvian approach combined with decompressive craniectomy can produce a greater improvement in long-term neurological function than small bone window craniotomy. However, there is no significant difference in postoperative intracranial infection rate between them.