透明导管鞘辅助神经内镜颅内血肿清除的应用研究

The exploratory development of endoscopic surgery in intracranial hematoma with transparent sheaths

目的采用透明导管鞘辅助神经内镜治疗高血压脑出血,与传统开颅术清除血肿作比较,探讨两者的优劣与特点。方法 40例高血压幕上脑出血患者随机分为透明导管鞘辅助神经内镜下颅内血肿清除组与开颅血肿清除术组,比较2组切口长度、骨窗大小、手术时间、术中出血量、术后血肿清除率、术后6个月GOS等临床资料。结果神经内镜组手术时间平均(76.1±15.5)min,开颅组为(191.5±28.1)min(P<0.05);神经内镜组术出血量平均(52.0±11.3)mL,开颅组为(455±127.9)mL(P<0.05);神经内镜组血肿清除率平均(87.3±6.0)%,开颅组平均(89±21.5)%(P>0.05);随访6个月神经内镜组恢复良好6例,轻度残疾6例,重度残疾4例,植物状态2例。开颅组恢复良好4例,轻度残疾4例,重度残疾4例,植物状态2例,死亡2例。神经内镜组患者与开颅组无明显统计学差异(P>0.05)。结论透明导管鞘辅助神经内镜治疗高血压脑出血,手术创伤小、时间短、并发症少、恢复快,能很大程度降低病死率、致残率,效果良好,值得临床推广应用。

Objective To compare endoscopic surgery in intracranial hematoma with transparent sheaths with traditional craniotomy to remove the hematoma,and explore the advantages and disadvantages,as well as characteristic.Methods 40 cases of hypertensive cerebral hemorrhage,bleeding site located on the tentorium of cerebellum,but not cerebral herniation.They were randomly divided into 2groups,endoscopic surgery in intracranial hematoma with transparent sheaths and craniotomy group;the incision length,bone window size,operative time,blood loss,rates of hematoma evacuation,GOS after 6months and other clinical data were compared.SPSS13.0analysis was used to make a comparison.Results Operative time of endoscopy group（76.1±15.5）min was shorter than（191.5±28.1）min of craniotomy group（P〈0.05）.Blood loss of endoscopy group（52.0±11.3）mL was much less than（455±127.9）mL of craniotomy group（P〈0.05）.Rates of hematoma evacuation had no significant difference：endoscopy group was（87.3±6.0）%,craniotomy group was（89±21.5）%（P〉0.05）,with 6-month follow-up,6cases with endoscopy group good recovery,6cases with mild disability,4cases of severe disability,2cases with vegetative state.In craniotomy group,4cases with good recovery,4cases with mild disabilities,4cases with severe disability,2cases with vegetative state and 2cases died,which had no significant difference（P〉0.05）.Conclusion Endoscopic surgery in intracranial hematoma with transparent sheaths is a new form of intracranial hematoma surgery,with the advantages of less trauma,short operative time,few complications,quick recovery,and can greatly reduce mortality and morbidity,and has a good effect.As a new and improved way,it is worthy of clinical application.