目的：探讨显微镜下小骨窗联合侧裂-岛叶入路治疗基底节区高血压脑出血的手术要点及疗效。方法：选取本院神经外科2011年1月-2014年1月收治的48例基底节区高血压性脑出血患者，所有患者早期均行显微镜下小骨窗联合侧裂-岛叶入路清除血肿治疗，分析其临床疗效。结果：所有患者术后即刻复查CT示：43例血肿基本清除，5例清除约80%。术后死亡4例，存活44例随访6~18个月，根据GOS评价，良好30例，中残10例，重残3例，死亡1例。结论：显微镜下小骨窗联合侧裂-岛叶入路治疗基底节区高血压脑出血具有微创的优点，术中显露满意，血肿清除较彻底，止血效果好，能够有效降低患者颅内压，同时减少颞叶皮层及血管损伤，术后致死、致残率低，值得在基层推广。%Objective:To investigate the operative key points and surgical treatment effect of small bone flap craniotomy combined with lateral fissure-insular approach under the microscope in the treatment of hypertensive basal ganglia hemorrhage. Method:48 patients with hypertensive basal ganglia hemorrhage admitted to our hospital from January 2011 to January 2014 were selected,at the early stage,they were given evacuation of hematoma treatment via small bone flap craniotomy combined with lateral fissure-insular approach under the microscope.Its clinical efficacy was analyzed.Result:The CT re-examination after postoperative immediately showed that the hematomas was removed all in 43 patients,over 80% in 5 patients,postoperative died in four patients.After 6 to 18 months follow-up,the GOS was good in 30 patients,mild disability in 10 patients,severe disability in 3 patients and 1 patient died.Conclusion:The treatment of hypertensive basal ganglia hemorrhage via a small bone flap craniotomy combined with lateral fissure-insular approach under the microscope has advantages such as minimal invasive,good exposure,comparatively complete hematomas removal, desirable effect stopping the blood flow,can effectively reduce intracranial pressure,while reducing the temporal lobe cortex and vascular injury,with low morbidity and mortality,is worth popularizing in the grassroots.
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