基底节区高血压脑出血内镜微创手术与开颅血肿清除术治疗的临床比较

A clinical comparison of endoscopic surgery versus craniotomy in hypertensive basal ganglia intracerebral hemorrhage

目的比较基底节区高血压脑出血内镜微创手术与开颅血肿清除术的临床疗效与特点。方法收集50例基底节区高血压脑出血患者手术时间、术中出血量、术后血肿清除量、术后颅内感染、术后6个月Glasgow预后评分（GOS）等临床资料，根据其治疗方案分为内镜微创手术组（内镜组）与开颅血肿清除术组（开颅组），以第6个月GOS评分作为预后指标，分析手术效果。结果内镜微创手术组与开颅血肿清除术组术前临床资料差异均无统计学意义（均P〉0．05）。手术时间：内镜组为（1．5±0．8）h，开颅组为（3．5±1．1）h（P〈0．05）；术中出血量：内镜组为（40．0±19．7）ml，开颅组为（40．6±13．2）ml（P〈0．05）；血肿清除率内镜组为（92．6±9．4）％，开颅组为（73．1±21．1）％（P〈0．05）；术后颅内感染：内镜组0例，开颅组3例（P〈0．05）；GOS预后，随访满6个月内镜组23例患者中恢复良好7例，轻度残疾12例，重度残疾2例，植物状态1例，死亡1例。开颅组25例患者中恢复良好6例，轻度残疾9例，重度残疾6例，植物状态3例，死亡1例。内镜组预后优于开颅组（P〈0．05）。结论内镜微创手术是一种微创、快速、高效、医疗成本低、患者经济负担轻的基底节区高血压脑出血手术方法。

Objective To compare the clinical effects and characteristics between hypertensive intracerebral hemorrhage （HICH） and haematoma clearance by craniotomy for basal ganglia. Methods Clinical data of 50 patients with HICH in basal ganglia were collected,including operation duration, amount of intraoperative bleeding, cleared amount of haematoma, postoperative intracranial infection, and GOS at the sixth month after operation. The patients were divided into endoscopic group and craniotomy group. Clinical effects were analyzed by using GOS at the sixth month as a prognosis index. Results Preoperatively, the two groups showed no significant difference in any type of clinical ma- terials （ all P 〉 0.05 ）. Operation durations were （ 1.5 ± 0.8 ） h and （3.5 ± 1.1 ） h （ P 〈 0.05 ）, respectively ; amounts of intraoperative bleeding were （40.0 ± 19.7） ml and （40.6 ± 13.2 ） ml （ P 〈 0.05 ）, respectively; clearance rates of haematoma were （92.6 ± 9.4） % and （73.1 ± 21.1 ） % （ P 〈 0.05 ）, respectively; cases of postoperative intracranial infections were 0 and 3 （P 〈 0.05 ）, respectively, for the endoscopy group and the craniotomy group. GOS prognosis at 6 months showed 7 cases of good recovery, 12 cases of slight disability ,2 cases of severe disability, 1 case of vegetative state, and 1 death in the endoscopy group ;6 cases of good recovery,9 cases of slight disability,6 cases of severe disability ,3 case of vegetative state, and 1 death in the craniotomy group. Prognosis was better in the endoscopy group than in the craniotomy group （P 〈 0.05 ）. Conclusion Endoscopic surgery is an efficient and minimally invasive and operating technique for the treatment of hypertensive basal ganglia intracerebral hemorrhage.