【摘要】：目的探討小骨窗經(jīng)外側(cè)裂-島葉入路顯微手術(shù)與立體定向穿刺引流術(shù)治療基底節(jié)區(qū)腦出血患者的臨床療效。方法選擇2012-2015年在某醫(yī)院被診斷為基底節(jié)區(qū)腦出血的患者110例,信封法隨機(jī)分為顯微組與引流組,各55例。顯微組手術(shù)方法由同側(cè)翼點(diǎn)入路,經(jīng)外側(cè)裂-島葉進(jìn)入基底節(jié)區(qū)清理血腫;引流組采用穿刺定位后置管引流顱內(nèi)血腫。對(duì)比分析兩組患者神經(jīng)功能缺損程度、臨床指標(biāo)、血清學(xué)指標(biāo)的差異。結(jié)果治療后,顯微組患者術(shù)后7 d和21 d SNSS量表評(píng)分、術(shù)后30 d GOS評(píng)分及術(shù)后3個(gè)月Barthel生活能力指數(shù)評(píng)分均明顯高于引流組,手術(shù)時(shí)間、術(shù)中引流(出血)量、腦血腫體積變化率、術(shù)后3 d和5 d腦水腫體積變化率較引流組明顯增加,再出血發(fā)生率、血腫殘留率、卒中相關(guān)性肺炎發(fā)生率、引流管置管時(shí)間明顯低于引流組,術(shù)后血清CRP、IL-6水平上升幅度小于引流組,差異均有顯著性(P0.05,P0.01)。結(jié)論小骨窗經(jīng)外側(cè)裂-島葉入路顯微手術(shù)可以有效清除基底節(jié)區(qū)腦內(nèi)血腫,降低患者血清學(xué)炎性反應(yīng)水平以及氧化應(yīng)激反應(yīng)程度,減輕出血區(qū)周圍腦組織水腫程度,改善臨床神經(jīng)功能缺損程度評(píng)分,臨床療效較好。
[Abstract]:Objective to investigate the clinical effect of microsurgery and stereotactic puncture and drainage through lateral fissure-insular approach in the treatment of intracerebral hemorrhage in basal ganglia. Methods 110 patients diagnosed as basal ganglia intracerebral hemorrhage in a hospital from 2012 to 2015 were randomly divided into microscopic group (55 cases) and drainage group (55 cases). In the microsurgery group, the hematoma was removed from the lateral fissure to the basal ganglia through the lateral fissure through the same flanking point approach, and the drainage group was treated with a puncture and a posterior tube to drain the intracranial hematoma. The degree of nerve function defect, clinical index and serological index were compared between the two groups. Results after treatment, the scores of SNSS scale on 7 and 21 days after operation, GOS scores on 30 days after operation and Barthel life ability index at 3 months after operation in the microscopic group were significantly higher than those in the drainage group, the operative time and the volume of drainage (bleeding) during the operation. The volume change rate of cerebral hematoma and the volume change rate of cerebral edema on the 3rd and 5th day after operation were significantly higher than those in the drainage group. The incidence of rebleeding, the residual rate of hematoma, the incidence of stroke associated pneumonia and the time of drainage tube placement were significantly lower in the drainage group than in the drainage group. The level of serum CRP,IL-6 in the drainage group was significantly higher than that in the drainage group (P 0.05 P 0.01). Conclusion the microsurgery via the lateral fission-insular approach can effectively remove intracerebral hematoma in the basal ganglia, reduce the level of serological inflammatory reaction and oxidative stress reaction, and reduce the degree of edema in the brain tissue around the bleeding area. The clinical curative effect is better by improving the grade of clinical nerve function defect.
【作者單位】： 磁縣人民醫(yī)院;
【分類號(hào)】：R651.1

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 王劍;許海;;高血壓腦基底節(jié)出血小骨窗微創(chuàng)手術(shù)治療20例臨床觀察[J];航空航天醫(yī)學(xué)雜志;2013年12期

2 劉濤;;小骨窗微創(chuàng)手術(shù)治療腦出血80例療效分析[J];現(xiàn)代診斷與治療;2014年01期

3 張大愚;;小骨窗微創(chuàng)手術(shù)治療腦出血療效分析[J];中國(guó)實(shí)用醫(yī)藥;2014年05期

4 余海浪;庹秀均;林建浩;;小骨窗微創(chuàng)手術(shù)治療腦出血療效分析[J];當(dāng)代醫(yī)學(xué);2013年06期

5 鄧人富;林云東;黃斌;羅忠平;李孝生;;小骨窗血腫清除術(shù)治療腦溢血的療效評(píng)價(jià)[J];當(dāng)代醫(yī)學(xué);2013年26期

6 李澤華;;小骨窗微創(chuàng)手術(shù)治療腦出血的臨床分析[J];中國(guó)衛(wèi)生產(chǎn)業(yè);2013年34期

7 張敬恂;;小骨窗微創(chuàng)手術(shù)治療腦出血的臨床觀察[J];現(xiàn)代診斷與治療;2013年16期

8 譚源福,黃祜鴻,梁裕盛,肖紹文,黃瑋;小骨窗直視下清除高血壓性腦出血(附56例分析)[J];中國(guó)臨床神經(jīng)外科雜志;2003年05期

9 王宏江;;小骨窗微創(chuàng)手術(shù)與傳統(tǒng)手術(shù)治療腦出血療效分析比較[J];中外醫(yī)療;2013年11期

10 張洪慶;;小骨窗微創(chuàng)手術(shù)治療腦出血的臨床觀察[J];吉林醫(yī)學(xué);2013年33期

相關(guān)會(huì)議論文 前7條

1 王保平;葉錦平;張翼;梅yN民;林偉;麻偉興;;小骨窗與傳統(tǒng)骨瓣開(kāi)顱在動(dòng)脈瘤手術(shù)應(yīng)用中的利弊分析附86例小骨窗手術(shù)報(bào)道[A];2009年浙江省神經(jīng)外科學(xué)術(shù)年會(huì)論文匯編[C];2009年

2 吳陽(yáng);許從甫;;微創(chuàng)小骨窗清除高血壓性腦出血[A];中國(guó)醫(yī)師協(xié)會(huì)神經(jīng)外科醫(yī)師分會(huì)首屆全國(guó)代表大會(huì)論文匯編[C];2005年

3 白凱;蘇永永;劉振鋒;劉永剛;劉江峰;吳鵬昌;魏亞輝;;小骨窗開(kāi)路顯微手術(shù)治療高血壓基底節(jié)區(qū)血腫[A];中華醫(yī)學(xué)會(huì)神經(jīng)外科學(xué)分會(huì)第九次學(xué)術(shù)會(huì)議論文匯編[C];2010年

4 黃楹;;顳下小骨窗夾閉后上循環(huán)破裂動(dòng)脈瘤[A];中華醫(yī)學(xué)會(huì)神經(jīng)外科學(xué)分會(huì)第九次學(xué)術(shù)會(huì)議論文匯編[C];2010年

5 劉家勝;張永福;;小骨窗直視下血腫清除治療高血壓腦出血在基層神經(jīng)外科中的應(yīng)用價(jià)值[A];中國(guó)醫(yī)師協(xié)會(huì)神經(jīng)外科醫(yī)師分會(huì)首屆全國(guó)代表大會(huì)論文匯編[C];2005年

6 徐宇倫;吳量;姚寧;王立淑;楊俊;;術(shù)中B超輔助下后顱窩小骨窗減壓結(jié)合枕大池重建術(shù)治療Arnold-Chiari畸形[A];中華醫(yī)學(xué)會(huì)神經(jīng)外科學(xué)分會(huì)第九次學(xué)術(shù)會(huì)議論文匯編[C];2010年

7 朱劍勇;;高血壓性腦出血外科治療方法淺析[A];中國(guó)醫(yī)師協(xié)會(huì)神經(jīng)外科醫(yī)師分會(huì)第二屆全國(guó)代表大會(huì)論文匯編[C];2007年

相關(guān)重要報(bào)紙文章 前2條

1 莫鵬;建立“小骨窗”逐個(gè)切腫瘤[N];健康時(shí)報(bào);2007年

2 杜帆;首例枕下乳突后小骨窗入路顯微鏡下小腦半球血腫清除術(shù)在延成功開(kāi)展[N];延安日?qǐng)?bào);2012年

相關(guān)碩士學(xué)位論文 前1條

1 汪亮;小骨窗顯微手術(shù)治療基底節(jié)區(qū)高血壓性腦出血最佳時(shí)機(jī)的選擇[D];安徽醫(yī)科大學(xué);2013年

，

本文編號(hào)：2323429