微创手术治疗高血压性脑叶出血的临床分析

Clinical analysis of minimally invasive surgery in the treatment of hypertensive lobar cerebral hemorrhage

目的探讨神经导航辅助神经内镜治疗高血压性脑叶出血的临床价值及疗效。方法将我科应用神经导航辅助神经内镜治疗高血压性脑叶出血35例(神经内镜组)与神经导航辅助显微镜治疗高血压性脑叶出血32例(显微镜组)的临床资料进行回顾性分析。比较2组手术时间、术中失血量、血肿清除率、术后并发症情况(主要观察包括应激性胃溃疡、肺部感染、泌尿系感染、颅内感染)、总住院时间及术后6个月日常生活能力(ADL)和病死率。结果神经内镜组平均手术时间、术中失血量少于显微镜组,而血肿清除率高于显微镜组(P<0.01);2组术后并发症发生情况差异无统计学意义,神经内镜组住院时间短于显微镜组(P<0.01);神经内镜组术后日常生活能力恢复情况优于显微镜组(P<0.05),2组的病死率差异无统计学意义(P>0.05)。结论神经内镜手术更微创、有效,可以改善高血压性脑叶出血患者的预后。

Objective To explore the clinical value and effect of neuronavigation-assisted neuroendoscopy for hypertensive lobar cerebral hemon＇hage. Methods Clinical data of 35 cases treated with the nem＇oendoscopy （neuroendoscopy group） and 32 cases treated with the neuronavigation-assisted microscope （microscope group） were retrospectively analyzed. Data of the operative time, intraoperative blood loss and the clearance rate of hematoma, the postoperative complications （stress gastric ulcer, puhnonary infection, urinary tract infection and intracranial infection）, the hospital stay, postoperative ability of daily life （ADL） in 6 months and fatality rates were obsmwed and compared. Results The operative time and intraoperative blood loss were less in the neuroendoscopy group than those in the microscopy group, and the clearance rate of hematoma was higher in neuroendoscopy group than that in the microscopy group （P 〈 0.01）. There was no significant difference in postoperative complications between the two groups （P 〉 0.05）. The hospital stay was less in the neuroendoscopy group than that of the microscope group （P 〈 0.01）. On the basis of ADL grading method, the prognosis of the endoscopy group was better than that of the craniotomy group （P 〈 0.05）. There was no significant difference in the fatality rate between the neuroendoscopy group and the microscopy group （P 〉 0.05）. Conclusion The neuronavigation- assisted neuroendoscopy is a safe and effective surgical method for hypertensive lobar cerebral hemorrhage, and which can improve the prognosis of patients with hypertensive intracerebral hemorrhage.