神经内镜辅助与枕下开颅血肿清除术治疗高血压小脑出血疗效比较

Neuroendoscopic hematoma evacuation in patients with hypertensive cerebellar hemorrhage

目的探讨神经内镜在高血压小脑出血患者治疗中的临床应用价值。方法回顾性分析38例小脑出血患者的临床资料,18例经神经内镜辅助下小脑血肿清除术,20例采用枕下开颅血肿清除术,统计两组患者的围手术期指标及临床转归。结果与开颅手术组比较,神经内镜组的平均手术时间缩短[(82.9±17.0)min vs.(177.9±28.8)min,t=12.545,P<0.01]、术中平均出血量减少[(45.1±15.6)mL vs.(197.9±29.5)mL,t=20.237,P<0.01]、术后脑室引流管留置时间缩短[(3.5±1.5)d vs.(5.3±1.4)d,t=3.751,P=0.001]、术后ICU留置时间缩短[(2.9±1.0)d vs.(4.7±1.5)d,t=4.146,P<0.01]、总住院时间缩短[(7.4±1.5)d vs.(9.9±2.8)d,t=3.348,P=0.002]。术后2周,神经内镜组死亡1例,开颅手术组死亡2例,差异没有统计学意义(P=1.000,P>0.05);随访3个月,神经内镜组格拉斯哥预后扩展评分(Glasgow Outcome Score Extended,GOSE)>4分14例,开颅手术组GOSE>4分13例,差异没有统计学意义(χ~2=0.752,P=0.386)。结论神经内镜辅助下小脑血肿清除术在死亡率与临床转归与枕下开颅手术没有差异,但是能缩短手术时间,减少术中出血,缩短脑室引流管留置时间,缩短ICU留置时间,缩短总住院时间,是安全、有效的手术方式,具有临床推广应用价值。

Objective The aim of our study was to examine the clinical value of neuroendoscopic surgery in hypertensive cerebellar hemorrhage. Methods The clinical data from 38 patients with cerebellar hemorrhage were retrospectively analyzed. Thirty-eight patients included 18 cases with neuroendoscopic hematoma evacuation（neuroendoscopic group） and 20 cases with craniotomy hematoma evacuation（craniotomy group）. The perioperative parameters and clinical outcome were statistically analyzed. Results Compared with craniotomy group, the mean operative time was shorter [（82.9 ±17.0）min vs.（177.9 ±28.8）min, t =12.545,P =0.000], the loss of mean blood volume was smaller [（45.1 ±15.6）mL vs.（197.9±29.5）mL, t= 20.237,P=0.000]ml, ventricle drainage time [（3.5 ±1.5）d vs.（5.3±1.4）d, t=3.751, P=0.001],ICU stay time [（2.9±1.0）d vs.（4.7±1.5）d, t=4.146, P=0.000] and hospital stay time [（7.4 ±1.5）d vs.（9.9 ±2.8）d, t =3.348, P =0.002] were shorter（P〈0.05）. Two weeks after surgery,1 cases died in neuroendoscopic group and 2 cases died in craniotomy group（ P=1.000, P〉0.05）. Three months after surgery, GOSE was greater than 4 in 14 cases in neuroendoscopic group and in 13 cases in craniotomy group and the difference was not significant（2 =0.752,P =0.386, P〉0.05）. Conclusion Although there are no differences in mortality and clinical outcomes between neuroendoscopic hematoma evacuation and occipital craniotomy hematoma evacuation for hypertensive cerebellar hemorrhage patients, neuroendoscopic hematoma evacuation can significantly reduce the mean operative time, the loss of mean blood volume, ventricle drainage time, ICU stay time and hospital stay time. Thus, neuroendoscopic hematoma evacuation in hypertensive cerebellar hemorrhage is safe and effective,which has a great value of application in the future.