Abstract: Objective To study the effect of non-tractive translateral cleft-insula approach (LFA) microsurgery (LFA) on the treatment of hypertensive basal ganglia hemorrhage (HBGH) in elderly patients.Methods A total of 100 HBGH in elderly patients treated in our hospital from January 2018 to December 2020 were selected and divided into LFA group (n=50) and control group (n=50) according to the surgical methods.The LFA group underwent LFA,and the control group underwent transtemporal cortical hematoma removal.The perioperative indexes such as operation time,hematoma residue,postoperative consciousness disturbance time and hematoma clearance rate were observed in both groups.Postoperative complications,Preoperative and postoperative intracranial pressure,serum levels of nerve injury factors such as vascular endothelial growth factor (VEGF),human chondoglycoprotein-39 (YKL-40),plus pentagprotein-3 (PTX3).Serum levels of stress factors such as β-endorphin( β-EP),Adrenocorticotropic hormone (ACTH),Cortisol (Cor).Prognosis at 6 months after surgery.Results The operation time,hematoma residue,postoperative consciousness disturbance time and hematoma clearance rate in LFA group were all lower than those in control group (P＜0.05).The incidence of postoperative complications in LFA group was lower than that in control group (P<0.05).On 7d after operation,the levels of serum VEGF,YKL-40,PTX3 and intracranial pressure in experimental group were lower than those in control group (P<0.05).On 7d after operation,the levels of serum β-EP,ACTH and Cor in experimental group were lower than those in control group(P＜0.05).GOS score of LFA group was better than control group 3 months after surgery (P＜0.05).Conclusion LFA therapy for HBGH in elderly patients can effectively remove hematoma,repair hemorrhagic spots,reduce brain nerve injury and systemic stress response,and contribute to the rehabilitation of patients,and has the advantages of less trauma,less postoperative complications,and better prognosis of patients.

Key words: Hypertensive basal ganglia hemorrhage, Old age, Non-tractured translateral fissure insula approach microscopy, Nerve injury factor, Stress factors, Prognosis

摘要： 目的 研究无牵拉经侧裂岛叶入路(LFA)显微镜手术(下称经LFA术)治疗老年高血压基底节区脑出血(HBGH)的效果;方法 选取2018年1月~2020年12月于我院治疗的老年HBGH患者100例,按照手术方法分为LFA组(n=50)、对照组(n=50)。LFA组行经LFA术,对照组行经颞叶皮质造瘘血肿清除术。观察两组手术时间、血肿残留量、术后意识障碍时间、血肿清除率等围术期指标。术后并发症。术前、术后7d颅内压,血清血管内皮生长因子(VEGF)、人类软骨糖蛋白-39(YKL-40)、正五聚蛋白-3(PTX3)等神经损伤因子水平。血清β-内啡肽(β-EP)、促肾上腺皮质激素(ACTH)、皮质醇(Cor)等创伤应激因子水平。术后6个月预后情况;结果: LFA组手术时间、血肿残留量、术后意识障碍时间、血肿清除率等均小于对照组(P＜0.05)。LFA组术后并发症发病率小于对照组(P＜0.05)。术后7 d,LFA组血清VEGF、YKL-40、PTX3水平及颅内压均低于对照组(P＜0.05)。术后7 d,LFA组血清β-EP、ACTH、Cor水平均低于对照组,差异有统计学意义(P＜0.05)。LFA组术后3个月GOS评分等级优于对照组(P＜0.05);结论: 经LFA术治疗老年HBGH可有效清除血肿,修复出血点,减少脑神经损伤及机体应激,有助于患者康复,且具有创伤小,术后并发症少,患者预后好等优势。

关键词: 高血压基底节区脑出血, 老年, 无牵拉经侧裂岛叶入路显微镜手术, 神经损伤因子, 应激因子, 预后