神经内镜与小骨窗开颅手术治疗高血压脑出血的临床疗效比较

Clinical analysis of endoscopic and small bone window craniotomy in the treatment of hypertensive cerebral hemorrhage

目的比较神经内镜微创手术与小骨窗开颅血肿清除手术治疗高血压幕上脑出血的临床疗效。方法选取2014年11月至2016年5月期间,在大连医科大学附属第一医院神经外科住院就诊的56例高血压脑出血患者,依手术方式不同将患者分成神经内镜组和小骨窗开颅组。神经内镜组22例,小骨窗开颅组34例。比较两组手术时间、术中出血量、血肿清除率、死亡率、神经功能缺损程度变化和术后6个月随访情况。结果神经内镜组死亡0例,小骨窗开颅组死亡2例,两组间无统计学差异(P>0.05)。与小骨窗开颅组相比,神经内镜组平均手术时间短[(1.52±0.40)h]、术中出血量少[(35.61±13.52)m L]、血肿清除率高[(90.12±4.32)%],神经功能恢复快[神经功能缺失程度量表评分术后1周为(25.15±4.37),术后4周为(18.13±2.85)],P均<0.05,差异有统计学意义。术后6个月预后良好率神经内镜组(81.82%)高于小骨窗开颅组(65.63%),P<0.05,差异有统计学意义。结论对于出血量在30~50 m L、病情较轻的高血压幕上脑出血患者,神经内镜微创手术具有微创、快捷、血肿清除率高、出血少、恢复快、预后好等优势。

Objective To compare endoscopic minimally invasive surgery and small bone window craniotomy in the treatment of hypertensive supratentorial intracerebral hemorrhage. Methods During November 2014 to May 2016,56 cases of hypertensive intracerebral hemorrhage were treated in the Department of Neurosurgery at First Affiliated Hospital of Dalian Medical University. According to the surgical procedures,the patients were divided into endoscopic group（n = 34） and small bone window craniotomy group（n = 34）. The operation time,bleeding volume,hematoma clearance rate,mortality rate,neurologic impairment and prognosis after 6 months of operation were compared between the two groups. Results No death was observed in the endoscopic group; two patients died in the small bone window craniotomy group. There was no significant difference between the two groups（P〈0. 05）. Compared with the small bone window craniotomy group,the endoscopic group had shorter mean operation time [（1. 52 ± 0. 40） h],less bleeding [（35. 61 ± 13. 52） m L],higher hematoma clearance rate [（90. 12 ± 4. 32） % ],and sooner neural functional recovery [neurological deficit scale score after1 week（25. 15 ± 4. 37）,4 weeks after surgery（18. 13 ± 2. 85） ]; the differences were significant（P〈0. 05）. And 6months after surgery,the good prognosis rate of endoscopy group（81. 82%） was higher than that of small bone window craniotomy group（65. 63%）（P〈0. 05）. Conclusion For patients with mild hypertensive supratentorial intracerebral hemorrhage and bleeding volume between 30 ~ 50 m L,endoscopic surgery is minimally invasive and quick. It has high hematoma clearance rate,less bleeding,quick recovery and good prognosis.