三种微创手术方式治疗基底核区脑出血的效果比较

Comparison of efficacies of three minimally invasive surgical methods for basal ganglia hemorrhage

目的比较三种微创手术方法治疗基底核区脑出血的疗效、安全性和发生并发症的情况。方法根据手术方式不同,将107例基底核区脑出血病人分为内镜下血肿清除组(n=29)、立体定向血肿碎吸组(n=33)和小骨窗开颅显微手术组(n=45)。比较各组术前准备时间、手术时间和术中失血量。术后2d内复查CT,计算残余血肿量和血肿清除率。术后3个月按GOS预后评分评估治疗效果、病死率和手术并发症发生率。结果术前准备时间以定向组最长,达(146.1±57.0)min,与另外两组比较,差异有统计学意义(P<0.01);手术时间以开颅组最长,达(173.7±57.3)min(P<0.01);术中失血量以开颅组较多,达(293.3±166.6)ml(P<0.05);血肿清除率以内镜组最高,达(80.7±7.9)%(P<0.01);再出血和颅内感染发生率内镜组为10.3%,定向组为18.2%,开颅组为11.1%;病死率分别为0、9.1%、6.7%。GOS预后比较,Ⅱ级以上者在内镜组与定向组之间差异有统计学意义(P<0.05)。结论内镜辅助下血肿清除术既有创伤小,又有血肿清除彻底、止血可靠的优点,疗效确切,对不需行去大骨瓣减压的脑出血病人是一种较理想的微创手术方式。

Objective To compare the therapeutic efficacy, safety and complication incidence of three minimally invasive surgical procedures for basal ganglia hemorrhage. Methods According to the operation procedure, 107 patients with basal ganglia hemorrhage were divided into endoscopic surgery group. （n=29）, stereotactic burr-hole aspiration group （n=33） and small bone flap craniomy group （n=45）, The time of preparation for surgery and operation, and the blood loss volume during operation were compared among three groups, Computed tomography was reused to calculate the residual volume and clearance rate of hematoma within two days after operation. The neurological outcomes, case fatality rate and complication incidence were analyzed after three months of the surgery according to the Glasgow Outcome Scale （GOS）. Results The stereotactic burr-hole aspiration group had the longest preparation time （146.1±57.0 min）. Compared with the other two groups, the difference was observable （P〈0.01）. The small bone flap craniomy group had the longest operation time （173.7±57.3 min）, （P〈0.01）. The blood loss volume （293.3±166.6 ml） during operation in small bone flap craniomy group was relatively more than those in the other two groups （P〈0.05）. The endoscopic surgery group had the highest hematoma clearance rate （80.7±7.9%, P〈0.01）. The incidence rate of rebleeding and intracranial infection was 10.3% in endoscopic surgery ＇group, 18.2% in stereotactic burr-hole aspiration group and 11. 1% in small bone flap craniomy group, and the case fatality rate was 0, 9.1%, and 6.7% in the 3 groups respectively. The grade Ⅱ of the GOS had significant difference between the endoscopic surgery group and stereotactic burr-bole aspiration group （P〈 0.05）. Conclusion Endoscopic surgery not only leads to less tissue damage, but also has advantage of higher hematoma clearance rate and effective hemostasis resulting in better neurological functional outcomes, therefore is an ideal choice for cerebral hemorrhage patients who has no need of large bone flap craniectomy.