超早期高血压基底节区出血经侧裂岛叶入路手术治疗

目的总结超早期高血压基底节区出血经侧裂岛叶入路手术治疗方法及要点。方法回顾性分析总结我院2009年6月～2011年6月高血压基底节区出血23例超早期经侧裂岛叶入路显微手术,解剖侧裂池、颈内动脉池,清除血肿、完善止血,侧裂池放置引流管,骨瓣复位,术后第1天头部CT检查。结果 23例患者中血肿清除超过90%19例(82.6%),血肿清除70%2例(8.6%),再出血2例(8.6%).术后1周显效18例(78.3%),好转3例(13.0%)。术后死亡2例(8.7%);随访6～28个月,按日常生活能力(ADL)评分:I级6例,II级13例,II级1例,IV级1例。结论超早期经侧裂岛叶入路显微手术是高血压基底节出血(25～45ml)的理想治疗手段。

Microsurgical treatment transsylvian-insular approach for hypertensive basal ganglia hemorrhage during ultra-early period

Objective To summarize the clinical experience of microsurgical treatment transsylvian-insular approach for hypertensive basal ganglia hemorrhage during ultra-early period.Methods A total of 23 patients with hypertensive basal ganglia hemorrhage underwent microsurgical treatment within 6 hours after stroke.The sylvian cistern and carotid artery pool were opened intraoperative.The hematoma was evacuated and drainage tube was placed in sylvian cistern.The cranial bones were all reseted.CT scans were performed the first day post operation.Clinical records were analyzed retrospectively.Results After open surgery,hematoma was evacuated more than 90% in 19 patients,70% in 2.Postoperative recurrence of bleeding were found in 2 patients.18 cases got significantly effective and 3 cases turned better in 1 week.Two patiens died.Follow-up assessment according to the Activity of Daily Living Scale(ADL) for 6-28 months revealed a good recovery of grade 1 in 6 patients,grade 2 in 13,grade 3 in 1,grade 4 in 1.Conclusion Ultra-early microsurgical hematoma evacuation transsylvian-insular approach is an ideal scheme for hypertensive basal ganglia hemorrhage.