神经内镜结合管状撑开器在中量基底节区脑出血血肿清除术中应用

Application of nerve endoscope combined with tubular stent in the removal of hematoma in cerebral hemorrhage with middle basal ganglia

目的比较中量基底节脑出血经神经内镜结合管状撑开器血肿清除术与单纯皮层造瘘血肿清除术的效果。方法对本院2015年8月-2018年2月期间神经内科有关基底节区脑出血的所有病例进行了回顾性的分析,A组病例中所选用的血肿清除方法是单纯皮层造瘘法,B组则是神经内镜结合管状撑开器法,对两组患者手术时间、术中的出血量与出现感染的概率进行比较,同时24h后所用患者行头颅CT以观察残留血肿量、脑水肿的体积与脱水剂使用的剂量,以及术后3个月对所有患者行日常生活能力量表(activity of daily living,简写成ADL)评分来评价患者的总自理率以进行比较。结果经过不同方法的血肿清除术后,B组手术时间(2.12±0.61)较A组(3.92±1.54)明显短,且B组术中的出血量(68.18±15.83)明显少于A组(98.55±21.43)以及24h后B组残留血肿量(2.11±1.02)明显少于A组(5.22±1.95)、脑水肿的体积(7.23±2.56)与脱水剂使用的剂量(100±25)均是少于A组(15.48±2.35、200±50),同时B组的总自理率为92.5%(37/40)高于A组69.44%(25/36),两组有差异(P<0.01或P<0.05);B组出现感染的几率7.5%(3/40)与A组5.56%(2/36)无显著差异(P>0.05)。结论在临床上,对于中量基底节脑出血的患者选用神经内镜结合管状撑开器来清除血肿,不仅此为微创性手术且较为简便,使得手术时间短、术后出现感染的几率小、血肿清除较为满意以及治疗效果极为满意,而且手术过程较为轻柔,使得术后周围脑水肿体积小,术中的出血量减少。因此,此种治疗方法是值得临床医者将其广泛运用于临床中。

Objective To compare the effect of middle-volume basal ganglia cerebral hemorrhage through nerve endoscope combined with tube expander hematoma evacuation and simple cortical ostomy hematoma evacuation.Methods A retrospective analysis of all cases of cerebral hemorrhage in basal ganglia was conducted inthe Neurosurgery Department of our hospital from August 2015 to February 2018.The method of hematoma removal used in group A was a simple cortical ostomy method.Group Bwas treated with the nerve endoscope combined with the tube expander method.The operative time,intraoperative blood loss,and the risk of infection were compared between the two groups.At the same time,24 hours later,the patient used head CT to observe the residual hematoma volume,the volume of brain edema and the dosage of dehydrating agent,and the activity of daily living(ADL)score for all patients after 3 months of surgery to evaluate the patient’s total self-care rate for comparison.Results After hematoma removal by different methods,the operation time in group B(2.12±0.61)was significantly shorter than that in group A(3.92±1.54),and the amount of bleeding in group B(68.18±15.83)was significantly less than group A(98.55±21.43)and the residual hematoma volume in group B(2.11±1.02)was significantly lower than that in group A(5.22±1.95)after 24 h.The volume of brain edema(7.23±2.56)and the dose of dehydrating agent used(100±25)were significantly less than group A(15.48±2.35,200±50).The total self-care rate in group B was 92.5%(37/40)higher than that in group A(69.44%,25/36),and there was a difference between the two groups(P<0.01 or P<0.05).The risk of infection in group B(7.5%,3/40)was no significant different from group A(5.56%,2/36)(P>0.05).Conclusion Clinically,for patients with moderate basal ganglia cerebral hemorrhage,the use of God’s endoscope combined with a tubular expander to remove the hematoma is not only minimally invasive surgery but also is relatively simple,short operation time and postoperative probability of infection is small.The hematoma removal is satisfactory and the treatment effect is extremely satisfactory.The surgical procedure is gentle,making the volume of brain edema around the postoperative small,and the amount of bleeding during the operation is reduced.Therefore,this treatment method is worthy of being widely used by clinical doctors in clinical practice.