显微镜下经外侧裂入路治疗自发性基底节区脑出血的临床研究

目的比较显微镜下经外侧裂入路行血肿清除手术和常规传统经皮层开颅清除血肿手术在基底节区脑出血治疗中的临床优劣。 方法选择2017年1月至2018年12月汕尾市人民医院神经外科收治的60例基底节区脑出血患者作为研究对象，随机数字表法分为观察组和对照组，各30例。观察组患者采用显微镜下经外侧裂入路行血肿清除术治疗，对照组患者采用常规传统经皮层开颅清除血肿手术治疗，比较2组患者手术相关指标、术后并发症、炎症指标，以及临床预后的差异。 结果2组患者在术前GCS评分、术前血肿体积、血肿清楚率上差别不大，差异无统计学意义（P>0.05）；观察组患者术中出血量、术后清醒时间、住院时间小于对照组，住院费用少于对照组，癫痫、电解质紊乱、肺部感染的发生率低于对照组，差异有统计学意义（P<0.05）。2组患者在再出血、颅内感染、应激性胃肠道出血、深静脉血栓上差异无统计意义（P>0.05）；观察组患者血清炎性因子白细胞介素1、肿瘤坏死因子α、C反应蛋白水平均低于对照组，差异均有统计学意义（P<0.05）。2组患者在第3个月时生活质量评分平均秩次差异无统计学意义（P>0.05），观察组第6、12个月时的平均秩次小于对照组，差异有统计学意义（P<0.05）。 结论对基底节区脑出血血肿清除外科手术入路选择上，显微镜下经外侧裂入路较常规传统经皮层开颅入路能够减少手术出血量，缩短术后清醒时间和住院时间，降低术后并发症的发生率及炎性因子水平，节约医疗成本，以及改善患者远期生活质量。

Clinical study on the treatment of spontaneous basal ganglia cerebral hemorrhage by lateral fissure approach under microscope

ObjectiveTo compare the clinical advantages and disadvantages of hematoma removal through lateral fissure under microscope and conventional hematoma removal through cortical craniotomy in the treatment of spontaneous basal ganglia cerebral hemorrhage. MethodsSixty patients with basal ganglia cerebral hemorrhage admitted to neurosurgery department of The People’s Hospital of Shanwei City from January 2017 to December 2018 were selected as the objects, and they were randomly divided into observation group (30 cases) and control group (30 cases). Patients in the observation group were treated with hematoma removal through the lateral fissure approach under the microscope, while patients in the control group were treated with conventional hematoma removal through the cortical craniotomy. The differences in surgical indicators, postoperative complications, inflammatory factors index, and clinical prognosis between the two groups were compared. ResultsThere was no significant difference in preoperative GCS score, preoperative hematoma volume, and hematoma clarity between the two groups (P>0.05). The intraoperative blood loss, postoperative waking time, hospitalization time and hospitalization cost of the observation group were less than that of the control group, with statistically significant differences (P<0.05). The incidence of epilepsy, electrolyte disturbance and pulmonary infection in the observation group was lower than that in the control group, with statistically significant differences (P<0.05). There were no statistically significant differences in rebleeding, intracranial infection, stress gastrointestinal bleeding and deep vein thrombosis between the two groups (P>0.05). Serum levels of inflammatory factors interleukin-1, tumor necrosis factor-α, and C-reactive protein in the observation group were all lower than those in the control group, with statistically significant differences (P<0.05). There was no significant difference in the mean rank of quality of life score between the two groups at the 3^rd month (P>0.05), while the mean rank of the observation group at the 6^th and 12^th month was smaller than that of the control group, with statistically significant difference (P<0.05). ConclusionAmong spontaneous basal ganglia cerebral hemorrhage hematoma removal surgery approaches, compare to traditional transcortical approach craniotomy, under microscope through lateral fissure approach can reduce the surgical blood loss, shorten the waking time and postoperative hospital stay, reduce the incidence of postoperative complications and inflammatory factors level, saves medical cost, and improve the patients’ long-term quality of life.