微创钻孔引流术与小骨窗开颅术治疗中等量到大量基底节区高血压脑出血效果

Effect of minimally invasive drilling drainage and small bone window craniotomy in the treatment of moderate and large volume basal ganglia hypertensive cerebral hemorrhage

目的研究微创钻孔引流术、小骨窗开颅术用于中等量到大量基底节区高血压脑出血治疗的效果差异。方法 120例中等量到大量基底节区高血压脑出血患者,根据手术方法不同分为A组和B组,每组60例。A组患者行微创钻孔引流术治疗,B组患者行小骨窗开颅术治疗,对比两组手术指标(手术时间和术中出血量)、术后并发症情况、术后恢复指标(住院时间和神经功能缺损评分)及术后后遗症发生情况。结果 A组患者手术时间为(29.4±4.6)min短于B组的(52.8±13.2)min;A组患者术中出血量为(25.8±3.6)ml少于B组的(65.8±14.7)ml,差异有统计学意义(P<0.05)。A组患者术后并发症总发生率为6.67%,B组患者术后并发症总发生率为8.33%,两组对比差异无统计学意义(P>0.05)。A组患者住院时间为(20.2±3.6)d短于B组的(24.4±4.1)d,差异有统计学意义(P<0.05);且术后4周神经功能缺损评分低于B组,差异有统计学意义(P<0.05)。A组患者术后偏瘫、吞咽障碍和失语发生率分别为3.33%、5.00%、3.33%,均明显低于B组的13.33%、16.67%、15.00%,差异有统计学意义(P<0.05)。结论微创钻孔引流术和小骨窗开颅术治疗中等量到大量基底节区高血压脑出血疗效相当,均有助于促进患者神经功能的修复并改善预后,而微创钻孔引流术的创伤更小。两种术式均有优缺点,临床医师应严格把握手术适应证,综合评估患者的病情,合理选择手术方式。

Objective To study the different effects of minimally invasive drilling drainage and small bone window craniotomy in the treatment of moderate and large volume basal ganglia hypertensive cerebral hemorrhage.Methods A total of 120 patients with moderate and large volume basal ganglia hypertensive cerebral hemorrhage were divided by different surgical methods into group A and group B,with 60 cases in each group.Group A was treated with minimally invasive drilling drainage,and group B was treated with small bone window craniotomy.Comparison were made on operation indicators（operation time,intraoperative bleeding volume,and postoperative complications）,postoperative recovery indicators（hospitalization time,neurological deficit score and occurrence of postoperative sequelae） between two groups.Results Group A had shorter operation time as（29.4±4.6） min than（52.8±13.2） min in group B,and less intraoperative bleeding volume as（25.8±3.6） min than（65.8±14.7） ml in group B.Their difference was statistically significant（P0.05）.Group A had incidence of total postoperative complications as 6.67%,which was 8.33% in group B,and the difference was statistically significant（P0.05）.Group A had shorter hospitalization time as（20.2±3.6） d than（24.4±4.1） d in group B,and the difference was statistically significant（P0.05）.Group A had lower neurological deficit score in postoperative 4 weeks than group B,and the difference was statistically significant（P0.05）.Group A had obviously lower incidence of postoperative hemiplegia,dysphagia and aphasia respectively as 3.33%,5.00% and 3.33% than 13.33%,16.67% and 15.00% in group B,and their difference was statistically significant（P0.05）.Conclusion Minimally invasive drilling drainage shows equal efficacy with small bone window craniotomy in treating moderate and large volume basal ganglia hypertensive cerebral hemorrhage,and both help promote the repair of nerve function and improve the prognosis of patients,while minimally invasive drilling drainage has less trauma.Both surgical methods have advantages and disadvantages,clinicians should strictly grasp the indications of operation,comprehensively assess the patient＇s condition and choose surgical method reasonably.