临床外科杂志 ›› 2020, Vol. 28 ›› Issue (6): 541-544.doi: 10.3969/j.issn.1005-6483.2020.06.012

• • 上一篇    下一篇

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

  

  1. 安徽省滁州市第一人民医院神经外科 
  • 出版日期:2020-06-20 发布日期:2020-06-20

The value of cortical fistulation and intersulcus approach in the treatment of spontaneous basal ganglia hemorrhage

  • Online:2020-06-20 Published:2020-06-20

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

[1] 史江海 刘东斌 仝小刚 刘家峰 梁阔 方育 王喆 王晓辉 王悦华 李非. 内窥镜逆行胰胆管造影术后肝被膜下血肿破裂出血一例[J]. 临床外科杂志, 2020, 28(4): 399-399.
[2] 陈志明, 牟磊, 王洋等. 降低脑室腹腔分流术后堵管几率的临床研究[J]. 临床外科杂志, 2019, 27(9): 761-763.
[3] 吴分浪, 关则俭, 陈盛勇等. 脑室腹腔分流术后颅内感染20例诊治体会[J]. 临床外科杂志, 2019, 27(7): 615-617.
[4] 陈晓巍, 陈治军, 谢腾, 刘平非, 罗小程, 许强华, 丁锐. 腰大池腹腔分流术与脑室腹腔分流术治疗特发性正常压力脑积水的临床疗效及安全性研究[J]. 临床外科杂志, 2019, 27(1): 45-47.
[5] 赵悦 任海军. 不同时机微创颅内血肿穿刺引流术对高血压脑出血患者血清神经元特异性烯醇化酶、脑源性神经营养因子和同型半胱氨酸水平的影响[J]. 临床外科杂志, 2018, 26(9): 689-692.
[6] 邱红根 杨振华 杨家英等 . Lichtenstein无张力修补术治疗腹股沟疝247例回顾性分析 [J]. 临床外科杂志, 2013, 21(2): 134-135.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 郑楷炼;金钢. 胰十二指肠切除术动脉先行入路的评价与选择[J]. 临床外科杂志, 2017, 25(10): 728 -730 .
[2] 喻庆安;姜洪池;代文杰. 原发性甲状旁腺功能亢进合并高钙血症的临床病理特点及急诊处理[J]. 临床外科杂志, 2018, 26(6): 420 .
[3] 刘华 张军 林称意 郭家龙 刘涛 张群献 罗玲 程栋梁 王静. 胸腔镜辅助下结肠代食管术临床分析[J]. 临床外科杂志, 2018, 26(9): 676 -678 .
[4] 马先仕 陈洪刚 吴念寿 柯松 肖绪鹏. 三维可视化技术指导下腹腔镜联合胆道硬镜治疗肝胆管结石的疗效分析[J]. 临床外科杂志, 2018, 26(9): 699 -701 .
[5] 汪翔, 卜星平, 吴小涛. 微创单侧入路双侧减压固定与开放双侧减压固定治疗单间隙腰椎管狭窄症的疗效比较[J]. 临床外科杂志, 2018, 26(12): 951 -954 .
[6] 尉志鹏〓罗志强〓韩喆等. 外伤性左心室破裂后心跳停止16分钟抢救成功一例[J]. 临床外科杂志, 2019, 27(7): 630 .
[7] 杜京丽, 郭庆森, 郑茂煌, 刘益峰, 吴德柱. 微创胆总管切开取石不同手术方式的疗效对比研究[J]. 临床外科杂志, 2019, 27(8): 664 -667 .
[8] 李世亭. 颅神经疾病减压手术的传承与创新[J]. 临床外科杂志, 2019, 27(10): 835 -837 .
[9] 孙静秋, 朱从元, 王珂, 华玉明. 三种不同戳孔入路在腹腔镜阑尾切除术中的对比研究[J]. 临床外科杂志, 2019, 27(12): 1037 -1040 .
[10] 梁太平, 裴轶飞, 周建等. 主动脉夹层的治疗现状与未来[J]. 临床外科杂志, 2020, 28(6): 501 -503 .