术中B超辅助下经外侧裂-岛叶入路显微手术治疗-第三军医大学学报.DOCVIP

术中B超辅助下经外侧裂-岛叶入路显微手术 治疗基底节区脑出血* microneurosurgical operation through lateral fissure - insular approach with intraoperative B-mode ultrasound for cerebral hemorrhage in basal ganglia 何程1 林爱国2 * 王俊伟1 吴南1 孟辉1 冯华1 （1第三军医大学西南医院神经外科 重庆 邮编 400038） （2遂宁市第一人民医院神经外科 遂宁 邮编 629000） 摘要 目的 观察B超辅助下经外侧裂-岛叶入路显微手术治疗基底节区脑出血的疗效。方法 回顾性分析我院近2年81例高血压性基底节区脑出血患者在B超辅助下经外侧裂-岛叶入路显微手术清除血肿的疗效并随访。结果 术后3d内复查头颅CT血肿清除率为93.8℅。死亡7例（8.64﹪）。术后6～12月按日常生活活动（ADL）分级：Ⅰ级13例（16.05﹪），Ⅱ级29例（35.80﹪），Ⅲ级26例（32.10﹪），Ⅳ级5例（6.17﹪），Ⅴ级1例（1.24﹪）。结论 术中B超辅助下经外侧裂-岛叶入路显微手术是治疗高血压性基底节区脑出血的一种有效微创治疗方法。 ABSTRACT Objective, To observe the effect of microneurosurgical operation through lateral fissure - insular approach with intraoperative B-mode ultrasound for cerebral hemorrhage in basal ganglia.Method,81 patients with cerebral hemorrhage in basal ganglia treated by microneurosurgery through lateral fissure - insular were randomly extracted ,and clinical data were retro spectively ananlyed. Results, hematomas removing rate with postoperative CT reexamination in 3 days is 93.8℅. 7 cases died (8.64%). Activities of daily living (ADL) rating after 6 to 12 months postoperatively, 13 cases (16.05%) were gradeⅠ, 29 cases (35.80%) were gradeⅡ, 26 cases (32.10%) were grade Ⅲ, 5 cases (6.17%) were grade Ⅳ, and 1 cases (1.24%) was gradeⅤ. Conclusion, Microneurosurgical operation through lateral fissure - insular approach with intraoperative B-mode ultrasound for cerebral hemorrhage in basal ganglia is an effective minimally invasive treatment. 关键词 脑出血；基底节区；术中B超；显微神经外科；外侧裂入路 KEYWORDS cerebral hemorrhage, basal ganglia, intraoperative B-mode ultrasound, microneurosurgery, through lateral fissure approach 高血压脑出血是高血压的严重并发症之一，具有较高病死率及病残率 [1]。回顾性分析我院2008年01月～2009年12月在B超辅助下经外侧裂-岛叶入路显微手术清除高血压基底节区脑出血81例病例。现报道如下。 1 资料与方法 1.1一般资料 本组共有81例，男49例（60.49%），女32例（39.51%）；年龄50～75岁（平均62.3岁）。出血到手术时间5-8h，平均6h。 1.2 临床资料 入院时均有不同程度的意识障碍和颅内压增高表现。收缩压190+30 mmHg，舒张压：110+15mmHg。意识状况：清醒8例，嗜睡15例，昏睡19例，昏迷39例（其中单侧瞳孔散大的20例），无深昏迷患者。Glas