显微手术经侧裂-岛叶入路对基底节区高血压脑出血患者血肿清除和脑损伤的影响

doi:10.19854/j.cnki.1008-2425.2021.05.0008

摘要/Abstract

摘要： 目的探讨显微手术经侧裂-岛叶入路对基底节区高血压脑出血患者血肿清除以及脑损伤的影响。方法回顾性分析2017年4月~2020年7月本院神经外科收治的93例基底节高血压脑出血患者的临床资料,按显微手术入路不同,分为A组(经侧裂-岛叶入路,58例)和B组(经颞叶皮质入路,35例)。比较分析两组血肿清除率、并发症、脑损伤实验室指标[血清S100钙结合蛋白B(S100B)、神经特异性烯醇化酶(NSE)]和近期预后状况。结果 A组术后24 h血肿清除率＞90%者占86.21%,血肿清除率(94.60±3.05)%,均高于B组68.57%、(87.73±6.12)%,差异有统计学意义(P＜0.05)。A组术后再出血、肺部感染、消化道出血总发生率27.59%低于B组40.00%,差异有统计学意义(P＜0.05)。术前血清S100B、NSE水平与血肿量均呈正相关(r=0.858、0.713,P＜0.05),A组术后7 d血清S100B、NSE水平低于B组,差异有统计学意义(P＜0.05)。两组术后6个月近期预后比较,差异无统计学意义(P＞0.05)。结论显微手术经侧裂-岛叶入路治疗基底节区高血压脑出血效果显著,具有血肿清除充分、并发症少和减轻脑损伤的优点。

关键词: 基底节区高血压脑出血, 显微手术, 侧裂-岛叶入路, 血肿清除率, 脑损伤, S100钙结合蛋白B, 神经特异性烯醇化酶

Abstract: Objective investigate the effect of microsurgical transsylvian insular approach on hematoma clearance and brain injury in patients with hypertensive intracerebral hemorrhage in basal ganglia. Methods The clinical data of 93 patients with hypertensive intracerebral hemorrhage in basal ganglia treated in neurosurgery department of our hospital from April 2017 to July 2020 were retrospectively analyzed.According to different microsurgical approaches,they were divided into group A(58 cases via lateral fissure insular approach) and group B(35 cases via temporal cortex approach).Hematoma clearance rate,complications,laboratory indexes of brain injury[serum S100 calcium binding protein B(S100b),neuron specific enolase(NSE)] and short-term prognosis of the two groups were compared and analyzed. Results In group A,the hematoma clearance rate > 90% was 86.21%,and the hematoma clearance rate was(94.60±3.05)%,which was higher than 68.57% and(87.73±6.12)% in group B(P＜0.05).The total incidence of postoperative rebleeding,pulmonary infection and gastrointestinal bleeding in group A was 27.59%,which was lower than 40.00% in group B(P<0.05).Preoperative serum S100B and NSE levels were positively correlated with hematoma volume(r=0.858,0.713,P＜0.05).Serum S100B and NSE levels in group A were lower than those in group B 7 days after operation,and the difference was statistically significant(P＜0.05).There was no significant difference in the short-term prognosis between the two groups 6 months after operation(P＞0.05). Conclusion Microsurgical treatment of hypertensive intracerebral hemorrhage in basal ganglia via transsylvian insular approach is effective,with the advantages of sufficient hematoma clearance,less complications and less brain injury.

Key words: Hypertensive intracerebral hemorrhage in basal ganglia, Microsurgery, Sylvian insular approach, Hematoma clearance rate, Brain injury, S100 calcium binding protein B, Neural specific enolase

中图分类号:

R743.34

张爱军, 鲁友明, 陈鑫, 袁磊, 邹冬冬. 显微手术经侧裂-岛叶入路对基底节区高血压脑出血患者血肿清除和脑损伤的影响[J]. 立体定向和功能性神经外科杂志, 2021, 34(5): 294-298.

ZhangAiJun, LuYouming, ChenXin YuanLei, et al.. Effect of microsurgical transsylvian insular approach on hematoma clearance and brain injury in patients with hypertensive intracerebral hemorrhage in basal ganglia[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2021, 34(5): 294-298.

参考文献

[1] Chen LH,Li FJ,Zhang HT,et al.The microsurgical treatment for primary hypertensive brainstem hemorrhage:Experience with 52 patients[J].Asian Journal of Surgery,2021,44(1):123~130.
[2] Zhao C,Ma Z,Zhang Y,et al.Application of micromirror in microsurgical clipping to the intracranial aneurysms[J].Journal of Craniofacial Surgery,2018,29(3):e287~e290.
[3] 印佳,季海明,吕远.老年高血压脑出血患者微创术后再出血影响因素[J].中国老年学杂志,2020,40(3):486~489.
[4] 黑博,王佳,王伟,等.基底核区高血压脑出血的立体定向治疗[J].中华神经外科杂志,2019,35(1):63~66.
[5] Sun G,Li X,Chen X,et al.Comparison of keyhole endoscopy and craniotomy for the treatment of patients with hypertensive cerebral hemorrhage[J].Medicine,2019,98(2):e14123.
[6] Goyal N,Tsivgoulis G,Malhotra K,et al.Minimally invasive endoscopic hematoma evacuation vs best medical management for spontaneous basal-ganglia intracerebral hemorrhage[J].Journal of Neurointerventional Surgery,2019,11(6):237~244.
[7] Rienzo A D,Colasanti R,Esposito D,et al.Endoscope-assisted microsurgical evacuation versus external ventricular drainage for the treatment of cast intraventricular hemorrhage:results of a comparative series[J].Neurosurgical Review,2019,43(2):695~708.
[8] 张亮,赵保钢,付辉,等.青年患者高血压性基底节区脑出血经外侧裂入路治疗的预后危险因素分析[J].内蒙古医科大学学报,2020,42(3):239~241.
[9] Ana,María,Ferrete-Araujo,et al.Brain Injury Biomarker Behavior in Spontaneous Intracerebral Hemorrhage.[J].World neurosurgery,2019,132(8):e496~e505.
[10]高继英,石代乐,高晓玲,等.血清S100b和NSE及IL-2联合检测对HICH术后并发颅内感染的诊断价值[J].中华医院感染学杂志,2020,30(09):95~98.
[11]Griepp D W,Miller A,Moawad S,et al.Minimally Invasive Microsurgical Technique for Evacuation of Deep Intracerebral Hematomas[J].World Neurosurgery,2021,149(5):103~106.
[12]Alexopoulos G,Prim M,Khan M,et al.Minimally Invasive Evacuation of Severe Intraventricular Hemorrhage Using the BrainPath Endoport-Assisted Microsurgical System - ScienceDirect[J].World Neurosurgery,2020,134(2):e540~e548.
[13]F Pastor-Escartín,G García-Catalán,Holanda V M,et al.Microsurgical Anatomy of the Insular Region and Operculoinsular Association Fibers and its Neurosurgical Application - ScienceDirect[J].World Neurosurgery,2019,129(C):407~420.
[14]Zijlstra I A,Van D,Verbaan D,et al.Ruptured middle cerebral artery aneurysms with a concomitant intraparenchymal hematoma:the role of hematoma volume[J].Neuroradiology,2018,60(3):335~342.
[15]惠培泉,宋磊,王增武,等.新型立体定向仪辅助下经额穿刺引流术治疗高血压性基底节区脑出血的临床应用[J].中华神经医学杂志,2020,19(12):1240~1246.