额部入路锥颅血肿穿刺抽吸引流术治疗自发性基底核出血

目的探讨经额部入路锥颅血肿抽吸引流术治疗自发性基底核出血的临床疗效。方法选择自发性基底核出血患者154例,出血量均为50-80ml。按入院时间顺序,将患者随机分为额部入路组（79例）和颞部入路组（75例）。额部入路组经穿刺靶点定位后,采用经额部入路锥颅置管血肿抽吸引流术。颞部入路组采用传统颞部入路锥颅置管血肿抽吸引流术。比较两组术后7、14、30d的神经功能缺损评分（改良爱丁堡＋斯堪的那维亚评分标准）、残余血肿量以及脑疝、再出血、脑积水的发生率和死亡率。结果①术后7d复查头部CT,示额部入路组残余血肿平均体积明显低于颞部入路组（t=9.17,P〈0.01）;脑疝发生率及死亡率均低于颞部入路组,差异有统计学意义（χ^2=4.04;χ^2=4.53,均P〈0.05）;术后14及30d两组比较,神经功能缺损评分差异有统计学意义（t=9.48;t=16.81,均P〈0.05）;再出血、脑疝、脑积水、死亡率两组比较,差异无统计学意义（P〉0.05）。②术后30d内病例合并统计,额部入路组再出血、脑疝、脑积水发生率及死亡率分别为3.8%（3/79）、6.3%（5/79）、3.8%（3/79）、5.1%（4/79）;颞部入路组分别为16.0%（12/75）、18.7%（14/75）、5.3%（4/75）、21.3%（16/75）,除脑积水发生率差异无统计学意义外,其余差异均有统计学意义（P〈0.05）。结论经额部入路锥颅血肿抽吸引流术疗效及安全性优于传统的颞部入路手术方式。

Aspiration and drainage of spontaneous basal ganglia region hematomas through a skull hole in the posterior frontal region

Objective To investigate the clinical efficacy of aspiration and drainage for the treatment of spontaneous basal ganglia hematomas through a drilling skull hole at posterior frontal region.Methods A total of 154 patients with spontaneous basal ganglia hematomas were selected, and the volume of hematomas was 50-80 mL. The patients were randomly allocated into a posterior frontal approach group （n=79） and a temporal approach group （n=75） according to the order of admission. Through the skull hole a plastic tube was inserted, to the hematoma, aspiration and drainage was performed in the posterior frontal approach group, and the temporal approach group. Neurological deficit scores （modified Edinburgh-Scandinavia stroke scale） and residual hematoma volume 7, 14 and 30 days after the operation, and the incidence of mortality, cerebral herniation, rebleeding and hydrocephalus were compared between the two groups.Results ① Head CT re-examination 7 days after the operation showed that the mean volume of residual hematoma in the posterior frontal approach group was significantly lower than that in the temporal approach group （t=9.17,P〈0.01）, the incidence of mortality and cerebral herniation were lower than those in the temporal approach group, and there were statistical significances between them （χ^2=4.04, P〈0.05, χ^2=4.53, P〈0.05）, 14 and 30 days after the operation, there were significant differences between the two groups in neurological deficit scores （t=9.48, P〈0.05, t=16.81, P〈0.05）, there were no statistical significances in rebleeding, cerebral hernia and hydrocephalus between the two groups （P〉0.05）. ② Within 30 days after operation, the incidence of rebleeding, cerebral herniation and hydrocephalus and mortality in the posterior frontal approach group were 3.8% （3/79）, 6.3% （5/79）, 3.8% （3/79） and 5.1% （4/79）, respectively, and in the temporal approach group were 16.0%（12/75）, 18.7% （14/75）, 5.3% （4/75） and 21.3% （16/75）, respectively