显微手术治疗基底节区高血压脑出血临床分析

摘要

目的 探讨显微手术治疗基底节区高血压脑出血的临床疗效.方法 回顾性分析2013-07—2017-05郑州市第一人民医院36例基底节区高血压脑出血患者的临床资料, 采用经外侧裂-岛叶入路在显微镜下开颅清除血肿, 术后早期在神经重症监护室监护, 控制血压、神经营养及后期康复治疗.结果 36例患者均顺利完成手术, 术后次日复查头颅CT示脑内血肿清除理想.术后患者死亡3例 (7.14％), 其中2例死于脑疝所致脑干功能衰竭, 1例死于多脏器功能衰竭.术后6个月进行日常生活能力 (activities of daily living, ADL) 评定, Ⅰ级7例, Ⅱ级14例, Ⅲ级10例, Ⅳ级4例, Ⅴ级1例.结论 经外侧裂-岛叶入路显微手术治疗基底节区高血压脑出血能安全有效清除血肿, 对脑组织损伤小, 止血较为彻底, 病人恢复满意.%Objective To explore the curative effects of microsurgical clearance for hypertensive intracerebral hemorrhage in basal ganglia. Methods A retrospective analysis was performed based on the clinical data of 36 patients with hypertensive intracerebral hemorrhage in basal ganglia from July 2013 to May 2017.All patients were treated with transsylvian microsurgery, including Early postoperative care in the NICU, control of blood pressure, neurotrophy, and later rehabilitation treatment.Results All the 36 cases of operation were successful.Re-examination of head CT scans on the first postoperative day showed Intracerebral hematoma was completely removed, Three patients died after operation (7.14％):2 patients died of cerebral hernia caused by brainstem function failure, 1 patient died of multiple organ failure. The ADL grade assessment 6 months after operation showed gradeⅠ in 7 cases, grade Ⅱ in 14 cases, grade Ⅲ in 10 cases, grade Ⅳ in 4 cases, and grade Ⅴ in 1 case.Conclusion The transsylvian-transinsular microsurgery is a safe and effective surgical approach for hypertensive intracerebral hemorrhage in basal ganglia.and has advantages of little brain tissue damage, good haemostatic results, and satisfactory efficacy