神经内镜在高血压脑出血手术中的应用

Use of neuroendoscope in hypertensive intracerebral hemorrhage surgery

目的:探讨神经内镜在高血压脑出血手术中的临床应用价值。方法:将2014年1-6月在东莞市人民医院采用神经内镜手术治疗的20例高血压脑出血患者作为神经内镜组,选取2012年1月至2013年12月采用传统开颅手术治疗的30例高血压脑出血患者作为传统开颅组。对比两组一般手术情况、住院时间、住院费用、并发症发生率、术后6个月神经功能等。结果:神经内镜组手术时间、皮肤切口、皮层切口、骨窗大小、术中失血量、术后血肿量、ICU住院时间、总住院时间和总住院费用低于传统开颅组(P<0.05),血肿清除量、术后6个月ADL评分、FIM评分、GOS分级优于传统开颅组(P<0.05)。术后6个月,两组均无死亡病例发生。两组术后并发症发生率比较,差异无统计学意义(P>0.05)。结论:神经内镜治疗高血压脑出血具有创伤小、费用低、预后佳的特点,值得临床应用推广。

Objective： To investigate the clinical value of using neuroendoscopy in hypertensive intracerebral hemorrhage（ HICH） surgery. Methods： Twenty patients with HICH hospitalized and underwent neuroendoscopy in Dongguang Municipal People＇s Hospital between January and June 2014 were included in the neuroendoscope group. Thirty patients with HICH hospitalized in our hospital and conventional craniotomy between January 2012 and December 2013 were included in the conventional craniotomy group. The general surgery condition,hospital stay,hospital cost,complication incidence,and neurological function at 6 months after the operation were compared between the two groups of patients. Results： The operation time,skin incision,cortex incision,bone window size,intraoperative blood loss,postoperative hematoma volume,ICU hospital stay,total hospital stay,and total hospital cost in the neuroendoscope group were significantly lower than those in the conventional craniotomy group（ P〈0. 05）. Also,the hematoma aspiration volume,and ADL scores,FIM scores and GOS grade at 6 months after the operation in the neuroendoscope group were significantly better than those in the conventional craniotomy group（ P〈0. 05）. No death cases were found in the two groups at 6 months after the operation. There was no statistically significant difference in the incidence of postoperative complications between the two groups（ P〈0. 05）. Conclusion： Neuroendoscopy has minimal trauma,low cost,and good prognosis in the treatment of HICH,which justifies its widespread use in clinical practice.