关键词:

基底节出血, 锁孔手术, 直切口, 疗效

Abstract:

Objective To investigate the effect of temporal straight incision small bone window keyhole craniotomy in the treatment of basal ganglia hemorrhage. Methods A retrospective analysis was performed on 72 patients with basal ganglia hemorrhage who underwent craniotomy in the Department of Neurosurgery of the First Affiliated Hospital of Anhui Medical University from August 2018 to February 2022.There were 33 patients who had keyhole craniotomy（observation group）and 39 patients who had large⁃scale craniotomy（control group）. The surgical outcomes of the two groups were compared，including operation time，hematoma clearance ratio，postopera⁃ tive complications，and hospitalization，duration，hospitalization costs，state of consciousness at discharge，and prognosis. Results The comparison between the observation group and the control group showed that the craniotomy time in the two groups was（17.03 ± 4.60）min and（38.18 ± 8.49）min，respectively，the operation time was （130.73 ± 44.70）min and（211.10 ± 60.14）min，respectively. The clearance rates were（92.88 ± 5.33）% and （87.00 ± 15.00）%，respectively. The length of hospital stay was（16.88 ± 8.02）d and（22.79 ± 11.23）d，respec⁃ tively. The incidence of epidural hematoma was 15% and 41%，respectively. The incidence of muscle edema was 12% and 41%，respectively. The hospitalization expenses of the observation group were（10.47 ± 4.35）ten thousandyuan，and the control group was（13.08 ± 5.30）ten thousand yuan. The difference of the above indicators was statistically significant（P < 0.05）. In the observation group and the control group，the ICU stay time was（7.91± 5.40）d and（9.38 ± 8.34）d，the mechanical ventilation time was（6.06 ± 4.80）d and（6.90 ± 5.64）d，the GCS score at discharge was（12.38 ± 2.62）and（12.03 ± 2.40），the proportion of intracranial infection 0% and 5%， and the incidence rate of pulmonary infection was 55% and 51%，the incidence rate of postoperative rebleeding was 3% and 5%，and the incidence rate of postoperative deep vein thrombosis was 12% and 8%. There was no significant difference（P>0.05）. In the ADH assessment of the observation group and the control group at 3 months after operation，the proportion of normal function was（6.2%）and（2.7%），the proportion of mild function impair⁃ ment was（25.0%）and（24.3%），the proportion of moderate function impairment was（34.4%）and（32.4%）， and the proportion of severe function impairment was（28.1%）and（32.4%），death rate（6.3%）and（8.2%）. There was no significant difference in prognosis between the two groups（P > 0.05）. Conclusion In the treatment of basal ganglia hemorrhage，a temporal straight incision small bone window keyhole craniotomy has less trauma，a shorter craniotomy time，a high rate of hematoma removal，a significantly shorter operation time and hospitalization time，fewer complications，and lower hospitalization costs. It has a high safety and clinical application value，as well as good clinical efficacy.

Key words:

basal ganglia hemorrhage, keyhole surgery, straight incision, curative effect