目的：探讨经侧裂-脑岛入路小骨窗开颅血肿清除术治疗基底节区高血压脑出血的手术方法及临床疗效。方法2007年1月~2013年6月运用冷光源吸引器辅助下经侧裂-脑岛入路小骨窗开颅血肿清除术治疗基底节高血压脑出血104例，为治疗组，手术入路为经侧裂-脑岛入路，直视下以冷光源吸引器配合双极电凝清除血肿并止血。同期行骨瓣开颅经脑叶入路血肿清除术63例为对照组。本文分析两组患者的手术方法及临床疗效。结果两组患者均术后6 h内复查CT示：治疗组因再出血二次手术6例，血肿清除率>80%者73例，血肿清除率50%~80%者21例，血肿清除率<50%者10例。术后存活92例，按ADL分级，恢复良好65例，中残22例，重残5例，死亡及放弃治疗12例。对照组因再出血二次手术12例，血肿清除率>80%者16例，血肿清除率50%~80%者23例，血肿清除率<50%者24例。术后存活45例，按ADL分级，恢复良好14例，中残16例，重残15例，死亡及放弃治疗18例。两组患者按手术时间、术中失血、术中输血量、血肿清除率、术后存活率及半年生存质量ADL分级比较，差异有统计学意义(P<0.05)，治疗组明显优于对照组。结论冷光源吸引器辅助下经侧裂-脑岛入路小骨窗开颅血肿清除术治疗基底节区高血压脑出血为直视下手术，手术时间短，损伤小，血肿清除率高，止血可靠，疗效确切，是理想的手术方式，明显优于骨瓣开颅经脑叶入路清除血肿术，值得临床推广运用。%Objective To discuss the clinical results and surgical method in treatment of hypertensive intracerebral hemorrhage in basal ganglia. Methods From January 2007 to June 2013, the use of surgery treatment of hypertensive intracerebral hemorrhage in basal ganglia under direct vision assisted by the deep cold light suction in 104 cases,all the cases were done through lateral fissure-brain island approach,removing the hematoma with bipolar coagulation and hemostasis at sametime. This paper analyzed the group of patients with surgical methods and clinical efficacy. Results CT scan of intreatment group showed that there were 6 cases of secondary operation because of recurrent hemorrhage, and the hematoma-cleared rate>80% in 73 cases,50%-80% in 21 cases,<50% in 10 cases before operation within 6 hours. According to ADL classification,the 92 cases were alive after operation, good recovery in 65 cases, moderate disability in 22 cases, 5 cases of severe disability, death and give up treatment 12 cases. There was 12 cases of sec-ondary operation because of recurrent hemorrhage in control group, and the hematoma-cleared rate>80% in 16 cases,50%-80%in 23 cases,<50%in 24 cases before operation within 6 hours. According to ADL classification,the 45 cases were alive after operation in control group, good recovery in 14 cases,moderate disability in 16 cases,15 cases of se-vere disability,death and give up treatment 18 cases. There were significant differences between the two groups in op-eration time, intra-operative blood loss, the volume of blood transfusion, hematoma clearance rate, postoperative sur-vival rate and the survival quality ADL grading at half a year, and the indexes mentioned above in treatment group were better than those in control group. Conclusion Surgery treatment of hypertensive intracerebral hemorrhage in basal ganglia under direct vision by lateral fissure-brain island approach assisted by the deep cold light suction will shooter the operation time and lower the surgical injury,increase hematoma-cleared rate,it aslo has reliable hemostasis and more effective,so this method is worthy of clinical use.
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