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目的比较锁孔入路和传统开颅治疗基底节区高血压脑出血术后癫痫的疗效。方法收集2006年9月-2015年3月四川石油管理局总医院神经外科收治的基底节区高血压脑出血患者108例,随机分为两组:锁孔入路治疗组(58例)和传统手术组(50例)。两组患者围手术期均采用相同的管理方案,统计分析两组患者的年龄、性别、出血量、术后癫痫发生率、药物疗效及药物不良反应发生率等。结果两组患者术后随访2年,锁孔入路治疗组术后癫痫发作12例,1例发生癫痫持续状态,无死亡发生;有10例对单一抗癫痫药物(AED)治疗有效,7例出现药物不良反应。传统手术组术后癫痫发作22例,9例发生癫痫持续状态,并有5例因此死亡;仅5例对单一AED治疗有效,15例出现药物不良反应。分析显示两组患者术后癫痫的发生率、重症癫痫发生率、预后、单一AED控制率及药物不良反应等方面有统计学意义(P<0.05)。结论与传统开颅血肿清除术比较,锁孔入路极大减少基底节区高血压脑出血术后癫痫、重症癫痫及药物并发症的发生。锁孔入路治疗基底节区高血压脑出血是一种值得推崇的手术方式。
Objective To compare the efficacy of keyhole approach and traditional craniotomy in the treatment of epilepsy after basal ganglia hypertensive intracerebral hemorrhage. Methods A total of 108 patients with hypertensive intracerebral hemorrhage in the basal ganglia treated with neurosurgery in the General Hospital of Sichuan Petroleum Administration from September 2006 to March 2015 were randomly divided into two groups: keyhole approach (58 cases) and traditional Surgery group (50 cases). The same management scheme was adopted during the perioperative period in both groups, and the age, gender, blood loss, incidence of postoperative epilepsy, drug efficacy and adverse drug reactions were statistically analyzed. Results Two groups of patients were followed up for 2 years. There were 12 cases of postoperative epileptic seizures in the keyhole approach group and 1 case of epileptic seizures. No death occurred in 10 cases. A single anti-epileptic drug (AED) was effective in 10 cases. Seven cases Adverse drug reactions. In the conventional surgery group, there were 22 postoperative epileptic seizures and 9 patients had status epilepticus. Five patients died of the epilepsy. Only 5 patients were treated with a single AED and 15 patients developed adverse drug reactions. The analysis showed that the incidence of postoperative epilepsy, the incidence of severe epilepsy, the prognosis, the rate of single AED control and adverse drug reactions in both groups were statistically significant (P <0.05). Conclusion Compared with the traditional craniotomy, the keyhole approach greatly reduces the incidence of postoperative epilepsy, severe epilepsy and drug complications in patients with hypertensive intracerebral hemorrhage of basal ganglia. Keyhole approach to treating basal ganglia hypertensive intracerebral hemorrhage is a highly recommended surgical procedure.