【摘要】 目的:探讨小骨窗经外侧裂-岛叶入路显微手术与立体定向穿刺引流术治疗基底节区脑出血的优劣差异。方法:选取2017年1月-2018年1月本院收治的62例基底节区脑出血患者,按照随机数字法分为两组,对照组31例予以立体定向穿刺引流术,研究组31例予以小骨窗经外侧裂-岛叶入路显微手术治疗。比较两组患者临床指标、血清指标、术后神经功能缺损程度。结果:研究组血肿清除率(93.54%)明显高于对照组(25.80%),研究组再出血发生率(3.22%)明显低于对照组(12.92%),研究组卒中相关性肺炎发生率(9.67%)明显低于对照组(22.54%),差异均有统计学意义(P<0.05),两组颅内感染发生率比较差异无统计学意义(P>0.05)。研究组血肿体积变化率、引流(血)量明显高于对照组,研究组术后5 d脑水肿体积增加率、引流管置管时间均明显低于研究组,研究组手术时间明显长于对照组(P<0.05)。两组患者术前SOD、CRP、MDA、IL-6比较差异均无统计学意义(P>0.05),术后3 d两组SOD均显著降低,CRP、MDA、IL-6均显示升高,且研究组CRP、IL-6均低于对照组(P<0.05)。研究组GOS评分、术后21 d SNSS评分、Barthel评分、术后7 d SNSS评分均明显高于对照组(P<0.05)。结论:小骨窗经外侧裂-岛叶入路显微手术对基底节区脑出血疾病中脑血肿有很强清除效果,且能有效降低患者再次出血风险,减轻出血区周围脑组织水肿程度,改善患者神经功能。更多还原

【Abstract】 Objective:To explore the difference between the advantages and disadvantages of small bone window via lateral fissure-island approach microsurgery and stereotactic puncture drainage for cerebral hemorrhage in basal ganglia region.Method:Sixty-two patients with basal ganglia cerebral hemorrhage admitted in our hospital from January 2017 to January 2018 were randomly divided into two groups according to the random number method.31 cases In the control group were subjected to stereotactic puncture and drainage,and 31 cases in the study group were treated with small bone window via lateral fissure-island approach microsurgery.The clinical indicators,serum markers,and postoperative neurological deficits of two groups were compared. Result:The hematoma clearance rate in the study group(93.54%) was significantly higher than that in the control group(25.80%).The incidence of rebleeding in the study group(3.22%) was significantly lower than that in the control group(12.92%),and the incidence of stroke-associated pneumonia in the study group(9.67%) was significantly lower than the control group(22.54%),there were statistical significances(P<0.05).There was no significant difference in the incidence of intracranial infection between two groups(P>0.05).The hematoma volume change rate and drainage(blood volume) in the study group were significantly higher than those in the control group,the volume increase rate of brain edema and the drainage tube placement time were significantly lower in the study group,the operative time of the study group was longer than that of the control group,there were statistical significances(P<0.05).There were no significant difference in preoperative SOD,CRP,MDA and IL-6 between two groups before surgery(P>0.05).On the 3 rd day after the operation,SOD in two groups decreased significantly,and CRP,MDA,and IL-6 levels increased.The levels of CRP and IL-6 in the study group were lower than those in the control group(P<0.05).The GOS score,postoperative 21 d SNSS score,Barthel score,postoperative 7 d SNSS score of the study group were significantly higher than those of the control group(P<0.05).Conclusion:Small bone window via lateral fissure-island approach microsurgery has a strong clearance effect on cerebral hematoma in basal ganglia cerebral hemorrhage diseases and effectively reduces the risk of rebleeding in patients,reduces the extent of brain tissue edema around the hemorrhage area and improves the patients’ neurological function.更多还原