神经内镜微创手术与开颅血肿清除术治疗高血压脑出血疗效比较

A comparison analysis between endoscopy and craniotomy evacuation of hematoma for hypertensive intracerebral hemorrhage

目的探讨神经内镜微创手术与开颅血肿清除术治疗高血压脑出血的疗效。方法连续收集同一术者手术病例120例,分成开颅手术组和神经内镜手术组,每组60例。通过手术时间、血肿清除率、术后GCS、NICU滞留时间、术后并发症的出现和术后3个月GOS,比较两组手术疗效。结果所有120名患者接受持续随访,随访时间大于3个月。内镜手术组和开颅组2组病例术前临床资料无明显差异(P>0.05);手术时间内镜组为(1.5±0.4)h,开颅组为(3.9±0.6)h(P<0.01);血肿清除率内镜组为95.84%±2.72%,开颅组为87.48%±7.84%(P<0.01);术后第1、3、7天GCS评分内镜组分别为:10(6,12),12(8,13),13(10,13),开颅组分别为6(5,9),7(5,11),8(5,12()P均<0.01);NICU滞留时间内镜组为(3.55±4.21)d,开颅组为(9.10±4.72)d(P<0.01);术后并发症内镜组无颅内感染病例,坠积性肺炎5例;开颅组颅内感染6例,坠积性肺炎41例,内镜组优于开颅组(P均<0.05);术后3个月GOS评分,内镜组3(3,4),开颅组2(2,3)(P<0.01)。结论神经内镜手术治疗高血压脑出血具有微创高效的特点,是治疗脑出血的有效方式,多个方面优于开颅血肿清除术,值得临床推广。

Objective We investigated the value of endoscopic evacuation and craniotomy of the hypertensive intracerebral hemorrhage to determine which methods are more suitable for the patients. Methods One hundred twenty patients with hypertensive intracerebral hemorrhage participated this study. They were divided into classic surgical evaluation group （n=60） and endoscopic surgical evaluation group （n=60） according to their corresponding surgery strategies. Each patient was assessed by the preoperative Glasgow Coma Scale （GCS）, the mean rate and time of hematoma evacuation from onset to operation, the postoperative GCS, the mean time of admission in neuro-intensive care unit （NICU） and Glasgow Outcome Score （GOS） at 3 month after surgery. Results The continuous （≥ 3 months） follow-up surveys were all completed by 120 patients. There was no statistical difference in clinical data before operation between two groups （P 〉 0.05）. However, clearance of hematoma was much faster and more efficient in endoscopic surgical group than in classic surgical evaluation group （1.5±0.4 vs.3.9±0.6 h, P 〈 0.01; 95.84±2.72% vs.87.48±7.84%, P 〈 0.01）. The GCS scores were 10（6,12）,12（8,13） and 13（10,13） in endoscopic surgical group whereas were 6（5,9）,7（5,11）.8（5, 12） in craniotomy group at 1,3 and 7 d followed operation. GCS scores were higher in surgical group than in craniotomy group at all time points （P 〈0.01）. In addition, patients receiving endoscopic treatment showed a shorter NICU admission time than those receiving craniotomy （3.55±4.21 d vs. 9.10±4.72d, P 〈0.01）. The intracranial infection and hypostatic pneumonia were significantly lower in endoscopic than in craniotomy surgery group （0 vs.6 cases; 5 vs. 41 cases, P〈0.05）. The endoscopic treatment significantly improved the GOS seore compared with craniotomy [3 （3, 4）vs. 2 （2, 3 ）] （P 〈 0.01）. Conclusion Endoscopic evacuation of hematoma for hypertensive intracerebral hemorrhage is efficient and minimally invasive, which is superior to craniotomy.