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神经内镜与传统开颅手术治疗高血压脑出血的效果 比较
李星辉赵保钢付辉马国佛
0
()
摘要:
目的 对比神经内镜手术与开颅手术治疗高血压脑出血的近期效果。方法 回顾性连续 纳入 2019 年4 月至2020 年1 月北京市大兴区人民医院神经外科收治的高血压脑出血患者 40 例,均经 CT证实为幕上血肿。根据手术方式的不同,将40 例患者分为神经内镜血肿清除组(16 例)和开颅血肿 清除组(24 例)。通过比较两组患者的基线资料[性别、年龄、血肿量、出血部位、术前格拉斯哥昏迷量 表( GCS)评分、发病至手术治疗时间等]、手术相关指标(手术时间、术中出血量、血肿清除率、术后并发 症)以及治疗前与出院时日常生活能力评分(Barthel 指数)等评价两种治疗方式的效果。结果 40 例患 者中,基底节区血肿32 例,皮质下血肿4 例,丘脑出血4 例。两组间性别、出血部位、年龄、血肿量、术前 GCS 评分、发病至治疗时间差异均无统计学意义(均P> 0.05)。神经内镜血肿清除组手术时间明显少于 开颅血肿清除组 [2(1,3)h 比3(3,4)h;Z=76.5,P< 0.01],术中出血量明显少于开颅血肿清除组[100.0 (62.5,137.5)ml 比500.0(300.0,600.0)ml;Z=33.0,P< 0.01],组间差异均有统计学意义;神经内镜血肿 清除组血肿清除率明显高于开颅血肿清除组[83.84( 75.54, 88.89)%比58.91( 15.27, 84.23)%;Z=21.0, P=0.02]。神经内镜血肿清除组入院与出院时Barthel指数评分的差值高于开颅血肿清除组[35.0( 30.0, 35.0)比25.0(20.0, 30.0);Z=23.0,P=0.03],出院GCS评分高于开颅血肿清除组[15.0( 7.0, 15.0)比8.5( 5.0, 12.0);Z=42.0,P=0.02],组间差异均有统计学意义;开颅血肿清除组术后肺炎发生患者明显多于神经内 镜血肿清除组(9/24 比1/16,χ2=5.00,P=0.03)。结论 神经内镜下血肿清除术在改善患者近期预后方 面优于开颅血肿清除术,可尝试用于高血压脑出血患者的手术治疗。
关键词:  高血压脑出血  血肿清除  开颅手术  神经内镜手术
DOI:10.3969/j.issn.1009-6574.2020.07.005
基金项目:
Comparison of neuroendoscopy and traditional craniotomy in the treatment of hypertensive cerebralhemorrhage
Li Xinghui, Zhao Baogang, Fu Hui, Ma guofo
()
Abstract:
Objective To analyze and compare the short-term effect of neuroendoscopic surgery and craniotomy in the treatment of hypertensive cerebral hemorrhage. Methods From April 2019 to January 2020, 40 patients with hypertensive cerebral hemorrhage admitted to the Department of Neurosurgery of Daxing District People's Hospital of Beijing were retrospectively enrolled. All patients were confirmed as supratentorial hematoma by CT. According to different surgical methods, 40 patients were divided into neuroendoscopic group (16 cases) and craniotomy group( 24 cases). The effects of the two treatment methods were evaluate by comparing the baseline data of the two groups of patients[ gender, age, hematoma volume, bleeding site, preoperative Glasgow Coma Scale( GCS) score, time from onset to surgical treatment, etc.], surgery-related indicators (operating time, intraoperative blood loss, Hematoma clearance rate, postoperative complications) and the ability of daily living score( Barthel index) before treatment and at discharge. Results Among the 40 patients, 32 were hematomas in the basal ganglia, 4 were subcortical hematomas, and 4 were thalamic hemorrhages. There was no significant difference in gender, bleeding site, age, hematoma volume, preoperative GCS score,and time from onset to treatment between the two groups( all P>0.05). The operation time in neuroendoscopy group was significantly less than that in craniotomy group[ 2(1,3) h vs 3(3,4) h;Z=76.5,P < 0.01]. The intraoperative blood loss in neuroendoscopy group was significantly less than that in craniotomy group[ 100.00 (62.5,137.5) ml vs 500(300,600) ml;Z=33.0,P< 0.01], and the differences were statistically significant. The hematoma clearance rate in neuroendoscopy group was significantly higher than that in craniotomy group[ 83.84 (75.54, 88.89)% vs 58.91( 15.27,84.23)%;Z=21.0,P=0.02]. The difference of Barthel index score between preoperative and discharge in neuroendoscopy group was significantly higher than that in craniotomy group [35.0(30.0,35.0) vs 25.0(20.0,30.0);Z=23.0,P=0.03]. The GCS score at discharge in neuroendoscopy group was significantly higher than that in craniotomy group[ 15.0(7.0,15.0) vs 8.5(5.0,12.0);Z=42.0,P=0.02], with statistical significance. The incidence of postoperative pneumonia in craniotomy group was significantly higher than that in neuroendoscopy group( 9/24 vs 1/16,χ2=5.00,P=0.03). Conclusions Neuroendoscopic hematoma removal is better than craniotomy hematoma removal in improving the short-term prognosis of patients, and it can be tried for surgical treatment of patients with hypertensive cerebral hemorrhage.
Key words:  Hypertensive cerebral hemorrhage  Evacuation of hematoma  Craniotomy  Neuroendoscopy

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