脑室镜辅助下经额入路清除高血压性基底节血肿的手术分析

The surgical effects of venous endoscope-assisted palliative hematoma in treatment of basal ganglia hematoma

目的研究脑室镜辅助下经额入路治疗基底节血肿的手术效果。方法 40例基底市区脑出血患者,根据手术方法分为观察组和对照组,每组20例。观察组行CT检查确诊后,选择基底节血肿同侧额叶发迹内弧形手术切口,长约3 cm,行2 cm大小骨窗,脑针穿刺探及血肿后沿穿刺道缓慢置入工作套筒,在神经内镜直视下清除血肿。并与对照组常规骨瓣开颅手术治疗。对两种治疗方法术后血肿清除率、术后14 d根据神经功能受损情况进行疗效评定,及术后3个月随访患者的日常生活活动能力(ADL)分级情况。结果 2组患者术后复查颅脑CT提示,观察组的清除率显著高于对照组(P<0.05)。术后7 d血肿量、住院期间病死率及再出血例数比较差异无统计学意义(P>0.05),而观察组住院时间、手术时间较对照组明显缩短(P<0.05)。术后14 d观察组临床疗效优于对照组(P<0.05)。3个月随访显示,观察组ADL分级情况较对照组更加优良,患者预后更佳,生活自理能力更强(P<0.05)。结论脑室镜辅助下经额叶行基底节血肿清除的手术方式,做到了对脑组织创伤小、手术时间短、血肿清除率高、患者术后脑功能回复快的最佳效果。

Objective To investigate the surgical effects of ventriculoscope-assisted forehead approach for the treatment of basal ganglia hematoma. Methods Forty patients with cerebral hemorrhage in the basal area were divided into observation group（n = 20） and control group（n = 20） according to the surgical methods. In the observation group,after CT diagnosis,a curved incision was made in the anterior part of the frontal lobe with the basal ganglia hematoma in patients,with length of approximately 3 cm,and 2 cm bone window was drilled. After detecting the hematoma by puncture,the cerebral needle was slowly placed into the working set along the puncture path,to remove the hematoma under neuroendoscopy. The patients in the control group were treated with conventional craniotomy. The hematoma clearance rate of the two groups was observed. The therapeutic effect was evaluated according to the neurological impairment at 14 days after operation. The grading of the patients based on activity of daily living（ADL） was observed at 3-month follow-up. Results The posoperative CT scan showed that the clearance rate in observation group was significantly higher than that in control group（P〈0. 05）.There were no significant differences in the amount of hematoma,mortality during hospitalization,and the number of patients presenting with rebleeding at 7 days after operation between two groups（P〈0. 05）,while the length of hospital stay and duration of operation in observation group were significantly shorter than those in control group（P〈0. 05）. The clinical curative effects in observation group were superior to those in control group at 14 days after operation（P〈0. 05）. At 3-month follow-up,the ADL grading,the prognosis and self-care ability in observation group were superior to those in control group（P〈0. 05）. Conclusion Surgical removal of the basal ganglia hematoma via ventriculoscope-assisted forehead approach has the optimal effects,including smaller trauma of the brain tissue,shorter duration of operation,higher hematoma clearance rate and more rapid recovery of brain function after operation.