高血压脑出血神经内镜微创手术与开颅血肿清除术的临床比较分析

A comparison study of endoscopic surgery versus craniotomy in management of hypertensive intracerebral hemorrhage

目的比较高血压脑出血神经内镜微创手术与开颅血肿清除术的临床特点与疗效。方法收集77例高血压脑出血手术患者的手术时间、手术失血量和GCS评分等临床资料,根据其治疗方案分为神经内镜微创手术组与开颅血肿清除术组,以第3个月GOS评分作为预后指标。采用SPSS10.0,比较两种手术方式手术时间、手术失血量、血肿清除率及其GOS预后评分的差别,观察、分析手术疗效。结果神经内镜微创手术组与开颅血肿清除术组两组病例术前临床资料无明显差异(P值均>0.05)。在手术时间上,神经内镜组平均手术时间(1.6±0.5)h,开颅血肿清除术组平均手术时间(4.6±1.8)h(P<0.01);在手术失血量上,神经内镜微创组平均手术失血量33.2±6.2mL,开颅血肿清除术组平均手术失血量(406.4±305.6)mL(P<0.01);在血肿清除率上,神经内镜组脑内血肿平均清除率为88.6%±6.2%,开颅组平均血肿清除率为69.4%±27.9%(P<0.05);在GOS预后方面,在26例术后随访满3月神经内镜组患者中恢复良好6例,轻度残疾10例,重度残疾5例,植物状态4例,死亡1例(家属放弃治疗后院内死亡)。开颅组49例患者中,恢复良好7例,轻度残疾8例,重度残疾13例,植物状态12例,死亡6例。3例因经济原因在术后放弃治疗脱失。神经内镜微创组患者预后优于开颅组患者预后(P<0.05)。结论神经内镜高血压脑出血手术是一种更具有微创、高效、快速、出血少等特点的高血压脑出血手术方法。

Objective To evaluate endoscopic surgery of hypertensive intracerebral hemorrhage（HICH） comparing with craniotomy.Methods Seventy-seven hypertensive intracerebral hemorrhage （HICH） cases were randomly divided into 2 groups：endoscopy group（28 cases）and craniotomy group （49 cases）.The clinical results and characteristics were compared between 2 groups.Results There were no significant differences of preoperative clinical data between 2 groups.Operating duration of endoscopy group（1.6±0.5） h was shorter than that of craniotomy group （4.6±1.8） h （P0.01）.Blood loss of endoscopy group（33.2±6.2） mL was much less than that of craniotomy group（406.4±305.6） mL （P0.01）Rates of hematoma evacuation in endoscopy group（88.6%±6.2%） were higher tcompared with craniotomy group（69.4%±27.9%）（P0.05）.In endoscopy group,26 patients were followed up and evaluated by Glasgow Outcome Scale for at least 3 months.Among them,6 patients showed good recovery; 10 patients showed moderate disability; 5 patients showed severe disability,4 patients showed vegetative survival,and one patient died,respectively.In craniotomy group,46 patients were followed up and evaluated by Glasgow Outcome Scale for at least 3 months.Among them,7 patients showed good recovery; 8 patients showed moderate disability; 13 patients showed severe disability,12 patients showed veg etative survival and 6 patients died respectively.The GOS outcomes of endoscopy group were better than those of craniotomy group（P0.05）.Conclusions Endoscopic surgery is a fast and minimally invasive operating technique for the treatment of HICH.