[1]孙　青　刘永春　尤万春　高　薇　陆　挺　李金泉　陈　罡　王　中.经外侧裂-岛叶入路手术治疗高血压性基底节区出血的疗效分析[J].中国临床神经外科杂志,2019,(01):16-18.[doi:10.13798/j.issn.1009-153X.2019.01.004]
　SUN Qing,LIU Yong-chun,YOU Wan-chun,et al.Analysis of curative effects of surgery through transsylvian-insular approach on hypertensive basal ganglia hemorrhage[J].,2019,(01):16-18.[doi:10.13798/j.issn.1009-153X.2019.01.004]
点击复制

经外侧裂-岛叶入路手术治疗高血压性 基底节区出血的疗效分析()
分享到：

《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2019年01期
页码:
16-18
栏目:
论著
出版日期:
2019-01-25

文章信息/Info

Title:
Analysis of curative effects of surgery through transsylvian-insular approach on hypertensive basal ganglia hemorrhage
文章编号:
1009-153X（2019）01-0016-03
作者:
孙　青　刘永春　尤万春　高　薇　陆　挺　李金泉　陈　罡　王　中
Author(s):
SUN Qing;  LIU Yong-chun;  YOU Wan-chun;  GAO Wei;  LU Ting;  Li Jin-quan;  CHEN Gang;  WANG Zhong.
Department of Neurosurgery, The First Affiliated Hospital, Soochow University, Suzhou 215006, China
关键词:
高血压性脑出血; 基底节; 手术入路; 显微手术; 预后
Keywords:
Hypertensive basal ganglia hemorrhage;  Surgical approach;  Microsurgery;  Prognosis
分类号:
R743.34;R651.1+1
DOI:
10.13798/j.issn.1009-153X.2019.01.004
文献标志码:
A
摘要:
目的 探讨经外侧裂-岛叶入路显微手术治疗高血压性基底节区出血的疗效。方法 回顾分析手术治疗的59例高血压性基底节区出血的临床资料。根据手术方式，分为对照组（经颞叶皮层入路40例）以及观察组（经外侧裂-岛叶入路19例）。结果 观察组术中责任动脉发现率（42.1%，8/19）明显高于对照组（10%，4/40；P<0.05），术后再出血率（0%）明显低于对照组（20.0%，8/40；P<0.05）。术后半年，观察组GOS评分[（3.7±1.4）分]明显高于对照组[（2.6±1.4）分；P<0.05]，偏瘫侧肌力好转率（82.4%，14/17）明显高于对照组（51.9%，14/27；P<0.05）；但两组病死率、失语好转率均无统计学差异（P>0.05）。结论 经外侧裂-岛叶入路手术治疗高血压性基底节区出血技术容易掌握，实用性强，术后病情稳定，有利于改善病人预后。
Abstract:
Objective To investigate the curative effects of surgery through transsylvian-insular approach on hypertensive basal ganglia hemorrhage (HBGH). Methods The clinical data of 59 patients with HBGH, of whom, 40 underwent the surgery through transtemporal cortex approach (control group) and 19 through transsylvian-insular approach (observed group), were analyzed retrospectively. The outcomes of surgery were compared between both the groups. Results The rate of finding the artery responsible for bleeding was significantly higher in the observed group (42.1%, 8/19) than that (10%, 4/40) in the control group (P<0.05). The postoperative rebleeding rate (0.0%) was significantly lower in the observed group than that (20.0%, 8/40) in the control group (P<0.05). GOS scores [(3.7±1.4) points] half a year after the surgery was significantly higher in the observed group than that [(2.6±1.4) points] in the control group (P<0.05). The improvement rate of hemiplegia (82.4%, 14/17) was also significantly higher in the observed group than that (51.9%, 14/17) in the control group (P<0.05). Conclusion The tanssylvivan-insular approach microsurgery is helpful to reducing the rebleeding rate and improvement of the prognosis in the patients with basal ganglia hemorrhage.

参考文献/References:

[1] Feigin VL, Lawes CM, Bennett DA, et al. Worldwide stroke
incidence and early case fatality reported in 56 population-
based studies: a systematic review [J]. Lancet Neurol, 2009,
8(4): 355-369.
[2] Qureshi AI, Mendelow AD, Hanley DF. Intracerebral
haemorrhage [J]. Lancet, 2009, 373(9675): 1632-1644.
[3] Brott T, Broderick J, Kothari R, et al. Early hemorrhage
growth in patients with intracerebral hemorrhage [J]. Stroke,
1997, 28(1): 1-5.
[4] 孙夕峰，唐　勇，樊永忠. 不同手术入路对优势侧基底节
区脑出血患者语言功能恢复的影响[J]. 中国现代手术学
杂志，2017，21（6）：468-472.
[5] 陈　旭，杨　旭. 依达拉奉联合神经生长因子治疗重型
颅脑损伤的疗效分析[J]. 中国临床神经外科杂志，2018，
23（7）：479-481.
[6] 吴有志，罗良生，张　健，等. 经外侧裂-岛叶入路显微手
术治疗基底节区脑出血[J]. 中国临床神经外科杂志，
2012，17（9）：555-557.
[7] Kim SH, Kim JS, Kim HY, et al. Transsylvian-transinsular
approach for deep-seated basal ganglia hemorrhage: an
experience at a single institution [J]. J Cerebrovasc Endo-
vasc Neurosurg, 2015, 17(2): 85-92.
[8] 彭爱军，武永康. 基底节区出血对语言功能影响的研究进
展[J]. 实用临床医药杂志，2012，16（15）：168-170.
[9] Komiya K, Sakai Y, Horikoshi T, et al. Recovery process and
prognosis of aphasic patients with left putaminal hemorr-
hage: relationship between hematoma type and language
modalities [J]. J Stroke Cerebrovasc Dis, 2013, 22(2): 132-
142.
[10] 范洪庚. 软通道与硬通道介入技术治疗高血压脑出血临
床疗效对比[J]. 中国综合临床，2010，26（11）：1206-1208.
[11] Cai Q, Zhang H, Zhao D, et al. Analysis of three surgical
treatments for spontaneous supratentorial intracerebral
hemorrhage [J]. Medicine (Baltimore), 2017, 96(43): e8435.
[12] 陈宏武，佘海锐，许晓明，等. 软硬通道技术治疗高血压脑
出血的应用研究[J]. 实用医技杂志，2018，25：298-300.
[13] 陈　浩，杜　涛，未平波，等. 软通道技术在中等量高血压
基底节区血肿的最佳手术时机研究[J]. 四川医学，2013，
34（7）：893-895.

相似文献/References:

[1]何明亮　黄浩炜　何永通　陈日朝.额部和颞部钻孔引流术治疗基底节区高血压脑出血的疗效[J].中国临床神经外科杂志,2015,(06):376.[doi:10.13798/j.issn.1009-153X.2015.06.022]
[2]孙其凯　李珍珠　曹智洁　高　强　王清波　陈　正　耿　鑫　李泽福.3D打印模型引导下经颞部穿刺引流术治疗颅内血肿[J].中国临床神经外科杂志,2016,(10):586.[doi:10.13798/j.issn.1009-153X.2016.10.004]
　SUN Qi-kai,LI Zhen-zhu,CAO Zhi-jie,et al.Treatment of hypertensive cerebral hemorrhage by the minimally invasive puncture via temporal region under the guidance of 3D printing model[J].,2016,(01):586.[doi:10.13798/j.issn.1009-153X.2016.10.004]
[3]何明亮,易铭佳,何永通,等.DTI技术在穿刺引流术治疗高血压性基底节区出血疗效评估中的价值[J].中国临床神经外科杂志,2016,(11):682.[doi:10.13798/j.issn.1009-153X.2016.11.010]
　HE Ming-liang,CHEN Rong-hao,CHEN Yin-yan,et al.Clinic effects of minimally invasive techniques on conscious patients with hypertensive basal ganglia hemorrhage and evaluation of the effects[J].,2016,(01):682.[doi:10.13798/j.issn.1009-153X.2016.11.010]
[4]白宗旭,师　蔚,姜海涛.高血压性脑出血的个体化手术治疗[J].中国临床神经外科杂志,2016,(11):717.[doi:10.13798/j.issn.1009-153X.2016.11.025]
[5]张　淇,李　辉,方开萱.个体化手术治疗对不同部位高血压性脑出血近期预后的影响[J].中国临床神经外科杂志,2016,(12):762.[doi:10.13798/j.issn.1009-153X.2016.12.010]
　ZHANG Qi,LI Hui,FANG Kai-xuan.Effects of individualized surgical plan on recent prognoses in patients with hypertensive intracerebral hemorrhage[J].,2016,(01):762.[doi:10.13798/j.issn.1009-153X.2016.12.010]
[6]吴　亮,宋子木,夏鹤春,等.垂体脓肿的临床特点及经鼻蝶显微手术治疗[J].中国临床神经外科杂志,2016,(12):771.[doi:10.13798/j.issn.1009-153X.2016.12.013]
[7]李红闪,朱海涛,史彦芳,等.经侧裂-岛叶入路小骨窗显微手术治疗高血压性基底节区出血[J].中国临床神经外科杂志,2016,(12):777.[doi:10.13798/j.issn.1009-153X.2016.12.016]
[8]梁观钦,蔡厚洪,吴　举.多靶点软通道穿刺术治疗高血压性脑内巨型血肿[J].中国临床神经外科杂志,2016,(12):787.[doi:10.13798/j.issn.1009-153X.2016.12.021]
[9]曾祥义　彭　涛.外周血淋巴细胞/单核细胞比值与高血压性脑出血血肿扩大的关系[J].中国临床神经外科杂志,2017,(01):7.[doi:10.13798/j.issn.1009-153X.2017.01.003]
　ZENG Xiang-yi,PENG Tao..Relationship of peripheral blood lymphocyte-to-monocyte ratio with hematoma enlargement in patients with hypertensive cerebral hemorrhage[J].,2017,(01):7.[doi:10.13798/j.issn.1009-153X.2017.01.003]
[10]陈燕豪,岑卓英,梁春妍,等.高血压性脑出血早期血肿扩大与血压变异性的关系[J].中国临床神经外科杂志,2017,(02):80.[doi:10.13798/j.issn.1009-153X.2017.02.006]
　CHEN Yan-hao,CEN Zhuo-ying,LIANG Chun-yan,et al.Relationship of hematoma enlargement with blood pressure variability early after hypertensive intracerebral hemorrhage[J].,2017,(01):80.[doi:10.13798/j.issn.1009-153X.2017.02.006]
[11]任允平.高血压性基底节区出血破入脑室的治疗体会[J].中国临床神经外科杂志,2016,(10):634.[doi:10.13798/j.issn.1009-153X.2016.10.025]
[12]石　浩,樊启涛,袁俊峰,等.小骨窗侧裂入路显微手术治疗高血压性基底节区出血的临床体会[J].中国临床神经外科杂志,2016,(11):715.[doi:10.13798/j.issn.1009-153X.2016.11.024]
[13]胡庆雷　陈维杰　张春华　张俊功　徐厚池福.血小板联合血浆治疗长期口服阿司匹林并脑出血的体会[J].中国临床神经外科杂志,2017,(03):195.[doi:10.13798/j.issn.1009-153X.2017.03.027]
[14]余浩,郭西良,马奎,等.简易体位辅助经额穿刺引流术治疗高血压性基底节区出血[J].中国临床神经外科杂志,2017,(07):480.[doi:10.13798/j.issn.1009-153X.2017.07.011]
　YU Hao,GUO Xi-liang,MA Kui,et al.Simple posture-assisted transfrontal puncture evacuation for hypertensive basal ganglia hemorrhage[J].,2017,(01):480.[doi:10.13798/j.issn.1009-153X.2017.07.011]
[15]阮航 杨国平 罗明 段发亮 闵强 张严国.经额部和经颞部入路导航辅助下内镜手术治疗高血压性基底节区出血的对比分析[J].中国临床神经外科杂志,2017,(10):693.[doi:10.13792017.09/j.issn.1009-153X.2017.10.007]
　RUAN Hang,YANG Guo-ping,LUO Ming,et al.Neuroendoscopic surgery under neuronavigation guidance for hypertensive basal ganglia hemorrhage: frontal appraoch vs.temporal approach[J].,2017,(01):693.[doi:10.13792017.09/j.issn.1009-153X.2017.10.007]
[16]千　超　王建峰.穿刺引流术治疗高血压性基底节区出疗效分析[J].中国临床神经外科杂志,2018,(01):33.[doi:10.13798/j.issn.1009-153X.2018.01.012]
[17]文　明　杨先清.去大骨瓣减压术治疗高血压性基底节区大量出血[J].中国临床神经外科杂志,2018,(01):45.[doi:10.13798/j.issn.1009-153X.2018.01.018]
[18]陈绪刚　黄前樟　董小清.小骨窗开颅术治疗老年高血压性基底节区出血[J].中国临床神经外科杂志,2018,(05):364.[doi:10.13798/j.issn.1009-153X.2018.05.022]
[19]李连进,佟建州,孙文栋,等.钻孔引流术联合重组组织型纤溶酶原激活剂治疗高血压性脑出血[J].中国临床神经外科杂志,2018,(09):624.[doi:10.13798/j.issn.1009-153X.2018.09.018]
[20]余　浩　张圣帮　施　建　邓鹏程　徐旭东　郭西良　张永明.经颅超声辅助经额钻孔引流术治疗高血压性基底节区出血[J].中国临床神经外科杂志,2021,26(07):546.[doi:10.13798/j.issn.1009-153X.2021.07.017]

备注/Memo

备注/Memo:
doi:10.13798/j.issn.1009-153X.2019.01.004 基金项目：国家重点研发计划（2018YFC1312600，2018YFC1312601）；江苏省青年医学重点人才计划（QNRC2016727） 作者单位：215006 江苏苏州，苏州大学附属第一医院神经外科（孙　青、刘永春、尤万春、高　薇、陆　挺、李金泉、陈　罡、王　中） 通讯作者：王　中，E-mail：w13306208761@hotmail.com
更新日期/Last Update: 2019-01-25