摘要目的 探讨经外侧裂-岛叶皮层入路手术治疗基底节区脑出血的临床效果.方法 回顾性分析2014年12月至2017年1月贵定县人民医院及贵州医科大学第三附属医院收治的52例基底节区脑出血患者的临床资料. 所有患者均采用经外侧裂-岛叶皮层入路手术治疗.结果 所有患者术后24 h复查头部CT,血肿清除>95%者47例(90.3%),血肿清除85% ~95%者5例(9.7%),无一例患者再出血. 术后两周内清醒病例49例(94.2%),一月内清醒2例(3.8%),随访6月,植物人1例(2.0%). 应用日常生活能力评分,Ⅰ级16例(30.8%),Ⅱ级29例(55.7%),Ⅲ级6例(11.5%),Ⅳ级0例,Ⅴ级1例(2.0%). 结论 经外侧裂-岛叶皮层入路手术治疗基底节区脑出血,具有手术视野开阔,手术径路直接,距离短,血肿清除率高,止血彻底以及对皮层的损害轻微,神经功能恢复好等优点.

abstractsObjective To investigate the clinical effect of the trans lateral fissure-insular cortex approach for the treatment of cerebral hemorrhage in basal ganglia region.Methods A retrospective study was performed on 52 cases of patients who were admitted from December 2014 to January 2017.Patients were diagnosed cerebral hemorrhage in basal ganglia region and were operated trans lateral fissure-insular cortex approach.The clinical data was analyzed.Results Postoperative computed tomography(CT)after 24 hours of surgery revealed that,hematoma clearance more than 95%,in 47 cases(90.3%),hematoma removed 85% ~95% in 5 cases(9.7%),no re-bleeding occurred in any case.The 49 cases(94.2%)who regained normal consciousness within two weeks after surgery,and 2 cases(3.8%)in one month.Patients were followed up for 6 months,and 1 case(2%)was in vegetable state.Prognostic grading was according to Activity of Daily Living Scale(ADL)(Barthel index),16 cases(30.8%)were grade I,29 cases(55.7%)were gradeⅡ,6 cases (11.5%)were gradeⅢ,0 case was gradeⅣ,and 1 case(2%)was gradeⅤ.Conclusion The trans lateral fissure-insular cortex approach in the treatment of cerebral hemorrhage in basal ganglia was worth of clinical promotion because of a wide surgical vision,a direct and short surgical distance and high clearance of hemato-ma,complete hemostasis,mild cortex damage and well recovered nerve function.