本文選題：高血壓基底節(jié)區(qū)腦出血 + 經(jīng)側(cè)裂-島葉入路�。� 參考：《山西醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:對(duì)比研究經(jīng)側(cè)裂-島葉入路與經(jīng)顳葉皮層入路手術(shù)治療高血壓基底節(jié)區(qū)腦出血的療效為臨床上外科治療術(shù)式選擇上提供循證醫(yī)學(xué)依據(jù)。方法:通過(guò)計(jì)算機(jī)檢索中國(guó)知網(wǎng)、萬(wàn)方醫(yī)學(xué)、中國(guó)文獻(xiàn)數(shù)據(jù)庫(kù)(CBM和中文科技期刊數(shù)據(jù)庫(kù)(維普網(wǎng)),收集國(guó)內(nèi)公開(kāi)發(fā)表的比較經(jīng)側(cè)裂-島葉和顳葉皮層入路的隨機(jī)對(duì)照試驗(yàn)(RCT)檢索時(shí)限為建庫(kù)至2014.12。并逐一進(jìn)行文獻(xiàn)質(zhì)量評(píng)價(jià)和資料提取。文獻(xiàn)的質(zhì)量評(píng)價(jià)參考Coachrane協(xié)作網(wǎng)提供Rev Man5.1軟件進(jìn)行Meta分析。結(jié)果:最終共納入19個(gè)病例-對(duì)照研究,共計(jì)1609例受試者,其中包括806例經(jīng)側(cè)裂-島葉入路行手術(shù)治療的患者和803例經(jīng)顳葉皮層入路治療的患者,Meta分析的結(jié)果顯示:①GOS:TR組的近期預(yù)后高于TE組,其差異有統(tǒng)計(jì)學(xué)意義[0R=2.15,95%CI(1.37,3.37),P=0.0009];②ADL:TR組的遠(yuǎn)期預(yù)后高于TE組,其差異有統(tǒng)計(jì)學(xué)意義[0R=2.81,95%CI(2.05,3.86),P0.0001];③術(shù)后并發(fā)癥:TR組的遠(yuǎn)期預(yù)后高于TE組,其差異有統(tǒng)計(jì)學(xué)意義[0R=0.34,95%CI(0.24,0.49),P0.00001]④再出血:TR組的術(shù)后再出血低于TE組,其差異有統(tǒng)計(jì)學(xué)意義[0R=0.35,95%CI(0.19,0.66),P=0.001];⑤死亡率:TR組的死亡率低于TE組,其差異有統(tǒng)計(jì)學(xué)意義[0R=0.35,95%CI(0.20,0.62),P=0.0003]。結(jié)論:現(xiàn)有臨床研究資料顯示:(1)經(jīng)側(cè)裂-島葉入路與經(jīng)顳葉皮層入路對(duì)患者在術(shù)后6個(gè)月以內(nèi)、12個(gè)月以后預(yù)后的影響,經(jīng)側(cè)裂-島葉入路手術(shù)治療的病人不良預(yù)后發(fā)生率要低于經(jīng)顳葉皮層入路術(shù)后的病人。(2)經(jīng)側(cè)裂-島葉入路較經(jīng)顳葉皮層入路手術(shù)治療高血壓基底節(jié)區(qū)腦出血術(shù)后并發(fā)癥的發(fā)生率、再出血發(fā)生率、術(shù)后死亡率有所下降。
[Abstract]:Objective: to compare the therapeutic effects of lateral fissure-insular approach and temporal cortex approach in the treatment of hypertensive basal ganglia intracerebral hemorrhage. Methods: a computer search was carried out on the Chinese Medicine of Zhiwang, Wanfang Medicine, The search time of CBM and Chinese Journal of Science and Technology (CBM) and Chinese Journal of Science and Technology (WIP), which were collected and published in China, were compared with the RCTs of lateral fissure and temporal lobe cortex pathway. The retrieval time of RCTs was built up to December 12, 2014. And one by one literature quality evaluation and data extraction. The quality evaluation of the literature refers to the Coachrane cooperation network to provide Rev Man5.1 software for Meta analysis. Results: a total of 19 case-control studies were conducted, with a total of 1609 subjects. A meta-analysis of 806 patients with lateral fissure / insular approach and 803 patients with transtemporal cortex approach showed that the short-term prognosis of the 1 GOS: tr group was higher than that of the te group. There was significant difference in the long-term prognosis between the two groups [0.37 ~ 3.37 ~ 0.0009] the long term prognosis of ADL: tr group was higher than that of te group, and the difference was statistically significant [0R 2.81 ~ 95CII 2.05V 3.86P0.0001] 3. The long term prognosis in the + tr group was higher than that in the te group, and the long-term prognosis was higher in the + tr group than in the te group, and there was a significant difference in the long-term prognosis between the two groups (P 0.0001), and the long-term prognosis was higher in the + tr group than in the te group. The difference was statistically significant [0RU 0.3495 CIQ 0.240.49 / P 0.00001] 4 the postoperative rebleeding in the rebleeding TR group was lower than that in the te group, and the difference was statistically significant [0RRU 0.35,95CI0.190.66 P0. 001] 5 the mortality rate in the% tr group was lower than that in the te group, and the difference was statistically significant [0RU 0.35% 95CI 0.20 0. 62P0.0003]. Conclusion: the available clinical data show that the effect of translateral fissure / insular approach and transtemporal cortex approach on the prognosis of patients within 6 months and 12 months after operation. The incidence of adverse prognosis was lower in patients treated with lateral fissure and insular approach than that in patients undergoing transtemporal cortex approach (P < 0.05). The incidence of adverse prognosis was lower than that in patients with hypertensive basal ganglia hemorrhage via transtemporal cortex approach than that in patients with hypertensive basal ganglion intracerebral hemorrhage treated by transtemporal cortex approach. Incidence of complications, The incidence of rebleeding and postoperative mortality decreased.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R651.1

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