神经内镜辅助治疗高血压基底节区脑出血疗效观察

Endoscopic-assisted microneurosurgery for hypertensive intracerebral hematomas in basal ganglia region

目的 探讨神经内镜辅助下治疗高血压基底节区脑出血的临床疗效。方法 选择2011年6月—2013年6月收治的高血压基底节区脑出血患者50例,按照手术方式分为开颅基底节区血肿清除术（开颅组）29例和神经内镜辅助治疗基底节区脑出血手术（神经内镜辅助组）21例,血肿量30～100ml。比较2组手术平均时间、手术创面、血肿清除率、预后日常生活活动能力评定（ADL）的评分、病死率,并对两者的结果进行统计学分析。结果 神经内镜辅助组的手术时间远远少于开颅血肿清除组（P〈0.01）,手术创面上神经内镜辅助组的手术创面包括皮肤切口、骨窗大小、术中失血量等明显小于开颅血肿清除组（P均〈0.01）,神经内镜辅助组在血肿清除率方面优于开颅血肿清除组（P〈0.05）,患者预后ADL的评分方面神经内镜辅助组明显优于开颅血肿清除组（P〈0.05）,神经内镜辅助组死亡率低于开颅血肿清除组（P〈0.05）。结论 神经内镜辅助手术治疗高血压基底节区脑出血具有微创、省时、直视、ADL评分高等优点,为基底节区脑出血的治疗提供了新的治疗手段。

Objective To evaluate the therapeutic effects of the hypertensive hematomas in basal ganglia region by endoscopic-assisted microneurosurgery. Methods 21 cases with hypertensive hematomas in basal ganglia regions with endoscope-assisted microneurosurgery compared with 29 cases undergoing conventional craniotomy,to compare the average surgical time,operation wound,hematoma evacuation rate,the difference prognosis of ADL scores of two groups. And the two results were analyzed with statistics. Results The mean operative time of neuroendoscopy group was significantly shorter than that of craniotomy group（ P〈0. 01）. The average operation wound of neuroendoscopy group was smaller than that of craniotomy group（ P〈0. 01）,the average hematoma clearance rate of neuroendoscopy group was significantly higher than that of craniotomy group（ P〈0. 05）,the prognosis of neuroendoscopy group was better than that of craniotomy group（ P〈0. 05）,the mortality rate of neuroendoscooy group was significantly lower than that of craniotomy group（ P〈0. 05）. Conclusion Endoscopic-assisted microneurosurgery for hypertensie hematomas in basal ganglia regions was characterized by mini-invasion,time-saving,and direct-vision,and was a new approach in this field.