皮层造瘘及脑沟间入路手术治疗自发性基底节区脑出血的临床价值

doi:10.3969/j.issn.1005-6483.2020.06.012

摘要/Abstract

摘要： 目的：探讨皮层造瘘与脑沟间入路手术治疗自发性基底节区脑出血的临床价值。方法：2017年9月～2019年11月收治的自发性基底节区脑出血病人64例，根据治疗方法分成A组和B组，每组各32例。A组行脑沟间入路手术，B组采用传统皮层造瘘治疗。比较两组手术时间、术后苏醒时间、术后格拉斯哥预后（GOS）评分、血肿吸收时间以及住院时间，并比较两组近期疗效，分别在术前及术后1周、2周、4周观察血肿体积的变化，记录两组并发症情况，分析两种手术疗效与病人血肿是否破入脑室、出血量的关系。结果：A组病人术后苏醒时间、血肿吸收时间以及住院时间较B组明显缩短，术后GOS评分低于B组，差异有统计学意义（P＜0.05）。A组优良率为59.38%，B组为34.38%，两组比较差异有统计学意义（P＜0.05）。A组术后1周、2周、4周的血肿体积均小于B组，两组比较差异有统计学意义（P＜0.05）。两组并发症发生率比较，差异无统计学意义（P＞0.05）。A、B组出血量＜45ml病人的优良率均高于出血量≥45ml的病人，两组比较差异有统计学意义（P＜0.05）。结论：与传统皮层造瘘相比，脑沟间入路术能缩短术后苏醒、血肿吸收以及住院时间，提升术后恢复优良率，两种手术疗效均受病人出血量的影响。

关键词: 自发性基底节区脑出血, 脑沟间入路, 皮层造瘘, 血肿, 脑室

Abstract: Objective：To explore the therapeutic value of cortical fistulation and intersulcus approach in spontaneous basal ganglia hemorrhage.Methods：64 patients with spontaneous basal ganglia cerebral hemorrhage admitted to our hospital from September 2017 to November 2019 were divided into group A（n=32）and group B（n=32）according to the treatment method.In group A，the operation was performed through the inter sulcus approach，and in group B，the traditional cortical fistulation was performed.The operation time，postoperative recovery time，postoperative gos score，hematoma absorption time and hospitalization time of the two groups were compared，and the shortterm effects of the two groups were compared.The changes of hematoma volume were observed before operation and 1，2 and 4 weeks after operation respectively，the complications of the two groups were recorded，and the relationship between the two hand operation effects and whether the patients broke into the ventricle and the amount of bleeding was analyzed.Results：The postoperative recovery time，hematoma absorption time and hospitalization time in group A were significantly shorter than those in group B，and the postoperative gos score was significantly lower than that in group B（P<0.05）.The excellent and good rate of group A was 59.38%，which was significantly higher than that of group B（34.38%）（P<0.05）.The volume of hematoma after 1，2 and 4 weeks in group A was smaller than that in group B（P<0.05）.There was no significant difference in the incidence of complications between the two groups（P>0.05）.The excellent and good rates of patients with bleeding volume < 45ml in groups A and B were higher than those with bleeding volume ≥45ml（P<0.05）.Conclusion：Compared with traditional cortical fistula，intersulci approach can shorten postoperative awaking，hematoma absorption and hospital stay，and improve the rate of postoperative recovery.The efficacy of both surgeries is affected by the amount of blood loss of patients.

Key words: spontaneous cerebral hemorrhage in basal ganglia, intersulci approach, cortical fistulas, hematoma, ventricle

王根, 汤德刚, 王维东. 皮层造瘘及脑沟间入路手术治疗自发性基底节区脑出血的临床价值[J]. 临床外科杂志, 2020, 28(6): 541-544.

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