内窥镜辅助高血压脑出血的微创手术治疗

Hypertensive coerbral hematoma treated by surgical method aided with neuroendoscopy

目的探讨使用内窥镜治疗高血压脑出血的临床疗效。方法采用CT定位、锁孔入路、硬质内窥镜辅助对74例高血压脑出血患者行血肿清除术。残余血肿术中置管,术后24 h后血肿腔注射尿激酶1万u和自体血浆1 ml。治疗完成后,按GOS愈后评分标准进行近期疗效和远期疗效评分以判定疗效。结果该组74例与小骨窗血肿引流手术22例作对照,两组术前临床资料的差别无统计学意义(χ2<0.001,P>0.05)。但疗效评价小骨窗引流组近期优良率为45%,病死率24%,而该组优良率为79%,病死率为2.7%。结论内窥镜辅助行高血压脑出血血肿清除术,患者术后恢复快,能显著提高患者的生存质量,降低死亡率。

Objective: To approach the clinical effects on the treatment of hypertensive cerebral hemorrhage by using the endoscope. Methods: An operation to clear away hematoma was carried out on 74 cases with hpertensive cerebral hemorrhage guided by CT scan, keyhole approach and rigid endoscope, and tubes were inserted during the operation for the remnant hematoma. 24 hours later after the operation, 10,000 U of urokinase and 1 ml of autoplasm were injected into the hematoma cavity. After the treatment, the recent and late curative effects were evaluated according to the standards of GOS. Results: The 74 cases in treating group was contrasted with the 22 cases treated with the hematoma drainage through the ossicle window. For the two groups there were no statistical significances of the clinical data before the operation. For the treating group the effective rate was 79% and the death rate 2.7% while for the contrasting group the effective rate was 54% and the death rate 24%. Conclusions: The clearance, aided with the endoscope, of hematoma caused by hypertensive cerebral hemorrhage can obviously improve the patients′ life quality and reduce death rate.