微骨窗经侧裂—岛叶入路治疗高血压壳核出血临床研究

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1、山东医药2010年第50卷第28期微骨窗经侧裂一岛叶人路治疗高血压壳核出血临床研究张伟，张东，杨利军(1石家庄市第一医院，石家庄050011；2北京天坛医院)摘要：目的探讨微骨窗经侧裂一岛叶人路血肿清除术治疗高l札压壳核出fliL(HPH)的临床疗效。方法选择HPH患者63例，“{血量39—120ml、平均66ml。所有患者就诊时未出现脑疝征象。行微骨窗经侧裂一岛叶入路40例，行微骨窗皮质造瘘血肿清除术23例。结果行微骨窗侧裂一岛叶入路的40例患者在72h内清醒34例，14d内清醒1例，持续昏迷3例，21d内死亡2例。行微骨窗皮质造瘘的23例患者术后72

2、h内清醒13例，14d内清醒4例，持续昏迷5例，23d内死1例。左侧优势半球血肿患者经侧裂入路手术语言功能好于经皮质造瘘者。结论对于适当的病例选择微骨窗经侧裂一岛叶入路手术有利于更好的功能恢复。关键词：高血压；壳核iII血；脑出血；经侧裂一岛叶入路中图分类号：R651．1文献标志码：A文章编号：1002—266X(2010)28-0063-03Surgicaltreatmentofhypertensiveputaminalhematomasthroughtranssylvian-insularapproachZHANGWei，ZHANGDong，YANG

3、Li-jun(1fHospitalofShifiazhuangCity，Shijiazhuang050011，P．R．China)Abstract：0bjectiveToinvestigatetheclinicaleffectsofhype~ensiveputaminalhematomas(HPH)throughtrans—sylvian—insularapproach．MethodsSixty—threepatientsofHPHwithvolumeofhematomasfrom39to120mlaverage66mlwereenrolled．Allp

4、atientshavenosignsofherniation．Therewere23patientsreceivedtranscortiealsurgicaltreatmentand40patientsreceivedtranssylvian—insularapproachtoremovethehematomas．ResultsOfthe40patientswhowithtranssylvian—insularapproach，34patientssoberedinpostoperative72hours，1soberedinpostoperative1

5、4days，3lapsedintoapersistentcomastateand2diedinpostoperative21days．Ofthe23patientswhoreceivedtranscorticalsurgicaltreat—ment，13patientssoberedinpostoperative72hours，4soberedinpostoperative14days，5lapsedintoapersistentcomastateand1diedinpostoperative23days．Forthelanguagefunctionof

6、thepatientswithlefthemisphericdominancehemato—ma，patientswithtranssylvian—insularapproachwerebetterthanthosewhoreceivedtranscorticalsurgicaltreatment．Con-clusionTranssylvian—insularapproachisabetterchoiceforpatientswithlimitedextra—capsulartypehematomabywhichtherewillbeabetterpre

7、operativeneurologicalcondition．Keywords：hype~ension；putaminalhemorrhage；cerebralhemorhage；transsylvian—insularapproach我国的高血压脑出血发病率高于国外，其中高1．1临床资料选择HPH患者63例，男41例、女血压壳核出血(HPH)最多见，占所有脑内出血的22例，年龄25～84岁、平均51岁，发病至手术时间51％～55％。近十余年来HPH外科疗法的进展不1．5～30h，出血位置在壳核区，血肿量39～120ml、仅在于改善生命预后，而且更重视机

8、能预后、降低残平均66ml。优势半球出血29例，非优势半球出血废率和提高生存质量