标题：Rolandic点-岛叶入路与颞叶皮层入路小骨窗经侧裂开颅术治疗高血压基底节区出血的疗效及预后分析

      作者：朱禛菁 1，陈裕春 2，徐化 1    1.复旦大学附属华山医院浦东院区手术室，上海 201206；2.复旦大学附属华山医院虹桥院区NICU，上海 201399

      卷次： 2023年34卷9期

      【摘要】 目的 比较Rolandic点-岛叶入路与颞叶皮层入路小骨窗经侧裂开颅术治疗高血压基底节区出血的疗效及预后。方法 回顾性分析2020年8月至2021年8月在复旦大学附属华山医院收治的112例高血压基底节区出血患者的临床资料，所有患者均进行小骨窗经侧裂开路手术治疗，根据患者手术入路不同分为A组(Rolandic点-岛叶入路) 57例和B组(颞叶皮层入路) 55例，比较两组患者的临床疗效、围术期指标、手术前及术后两周的神经因子水平、预后及术后并发症发生情况。结果 A组与B组患者的治疗总有效率分别为98.25%、96.36%，差异无统计学意义(P>0.05)；A组患者的手术时间、住院时间分别为(3.41±0.60) h、(22.23±4.49) d，明显短于B组的(4.09±1.23) h、(31.08±5.15) d，差异均有统计学意义(P<0.05)；A组患者的血肿清除率(术后24 h)、术后1周格拉斯哥昏迷量表(GCS)评分分别为94.74%、(11.75±0.69)分，明显高于B组的80.00%、(10.81±0.57)分，差异均具有统计学意义(P<0.05)；手术后，两组患者的S-100β蛋白(S-100β)、胶质纤维酸性蛋白(GFAP)、水通道蛋白4 (AQP4)水平均降低，且A组患者的上述指标分别为(0.12±0.07) ng/mL、(3.62±0.48) pg/mL、(105.38±14.18) μg/L，明显低于B组的(0.16±0.06) ng/mL、(3.86±0.52) pg/mL、(111.19±12.73) μg/L，差异均具有统计学意义(P<0.05)；A组患者的预后优良率为94.74%，明显高于B组的81.82%，差异具有统计学意义(P<0.05)；A组与B组术后并发症发生率分别为7.02%、10.91%，差异无统计学意义(P>0.05)。结论 与颞叶皮层入路小骨窗经侧裂开颅术比较，Rolandic点-岛叶入路方式可缩短高血压基底节区出血患者手术时间、住院时间，提高血肿清除率，改善神经因子水平，改善预后。
      【关键词】 高血压基底节区出血；小骨窗经侧裂开颅术；Rolandic点-岛叶入路；颞叶皮层入路；疗效
      【中图分类号】 R544.1 【文献标识码】 A 【文章编号】 1003—6350（2023）09—1246—05

Efficacy and prognosis of small bone window transsylvian craniotomy via Rolandic point-insular lobe approachor temporal cortex approach in the treatment of hypertensive basal ganglia hemorrhage.
ZHU Zhen-jing 1, CHENYu-chun 2, XU Hua 1. 1. Operating Room, Pudong Branch, Huashan Hospital Affiliated to Fudan University, Shanghai201206, CHINA; 2. NICU, Hongqiao Branch, Huashan Hospital Affiliated to Fudan University, Shanghai 201399, CHINA
【Abstract】 Objective To compare the efficacy and prognosis of Rolandic point-insular lobe approach and tem-poral cortex approach for small bone window transsylvian craniotomy in the treatment of hypertensive basal gangliahemorrhage. Methods The clinical data of 112 patients with hypertensive basal ganglia hemorrhage treated in HuashanHospital Affiliated to Fudan University from August 2020 to August 2021 were retrospectively analyzed. All patients un-derwent small bone window transsylvian surgery. According to different surgical approaches, the patients were dividedinto group A (Rolandic point-insular lobe approach, 57 cases) and group B (temporal cortex approach, 55 cases). Theclinical efficacy, perioperative indicators, nerve factors levels before surgery and at 2 weeks after surgery, prognosis andoccurrence of postoperative complications were compared between the two groups of patients. Results The total effec-tive rates of treatment of groups A and B were 98.25% and 96.36%, respectively, with no statistically significant differ-ence (P>0.05). The surgical time and length of hospital stay were (3.41±0.60) h and (22.23±4.49) d in group A, signifi-cantly shorter than (4.09±1.23) h and (31.08±5.15) d in group B (P<0.05). The hematoma clearance rate at 24 hours aftersurgery and Glasgow Coma Scale (GCS) score at 1 week after surgery were 94.74% and (11.75±0.69) points in group A,which were significantly higher than 80.00% and (10.81±0.57) points in group B (P<0.05). After surgery, the levels ofS-100β protein (S-100β), glial fibrillary acidic protein (GFAP), and aquaporin 4 (AQP4) in both groups were decreased,and the levels of the above indicators were (0.12±0.07) ng/mL, (3.62±0.48) pg/mL, and (105.38±14.18) μg/L in group A,significantly lower than (0.16±0.06) ng/mL, (3.86±0.52) pg/mL, and (111.19±12.73) μg/L in group B (P<0.05). The ex-cellent and good rate of prognosis of group A (94.74%) was significantly higher than that of group B (81.82%), P<0.05.There was no statistically significant difference in the incidence rate of postoperative complications between group A(7.02%) and group B (10.91%), P>0.05. Conclusion Compared with small bone window transsylvian craniotomy viatemporal cortex approach, Rolandic point-insular lobe approach can better shorten the surgical time and hospital stay, in-crease the hematoma clearance rate, enhance the levels of nerve factors, and improve the prognosis in patients with hy-pertensive basal ganglia hemorrhage.
      【Key words】 Hypertensive basal ganglia hemorrhage; Small bone window transsylvian craniotomy; Rolandicpoint-insular lobe approach; Temporal cortex approach; Efficacy