神经内镜手术治疗丘脑出血破入脑室的临床观察

The application value of neuroendoscopy in the surgery of thalamic hemorrhage penetrating cerebral ventricles

目的探讨神经内镜在丘脑出血破入脑室手术中的应用价值。方法 30例丘脑出血破入脑室患者采用神经内镜治疗为试验组,脑室外引流术治疗34例为对照组,观察2组血肿清除率,手术情况及预后。结果试验组术后并发症总发生率及再出血发生率低于对照组(P<0.05)。术后24 h复查脑CT,计算血肿清除率,试验组血肿清除率高于对照组(P<0.05),且清除率>90%(基本完全清除)率高于对照组(P<0.05)。动态监测2组脑CT结果显示,随着治疗时间的延长,2组患者血肿体积均明显缩小,且试验组少于对照组(P<0.05)。试验组术中出血量及手术时间多于对照组,但术后引流管放置时间短于对照组,差异有统计学意义(P<0.05)。2组患者术后随访6个月,试验组预后优良率为70.83%,死亡率为4.17%;对照组分别为46.67%、10%,2组优良率比较差异有统计学意义(P<0.05)。结论神经内镜治疗丘脑出血破入脑室,具有创伤小、血肿清除率高、预后好的优点,值得临床推广。

Objective To investigate the application value of neuroendoscopy in the surgery of thalamic hemorrhage penetrating cerebral ventricles. Methods Thirty patients with thalamic hemorrhage penetrated into cerebral ventricles were enrolled as experimental group,who were treated by endoscopic surgery,and the other 34 patients who underwent external ventricular drainage were enrolled as control group. The hematoma clearance rate,operation status and prognosis of patients were observed and compared between two grousp. Results The total incidence of postoperative complications and incidence of rebleeding in experimental group were significantly lower than those in control group（ P〈0. 05）. The CT scan at 24 hours after operation showed that the hematoma clearance rate in experimental group was significantly lower than that in control group（ P〈0. 05）,moreover the complete clearance rate（ 90%） in experimental group was significantly lower than that in control group（ P〈0. 05）. The dynamic CT scan results showed that with the prolongation of treatment time,the hematoma volume was significantly reduced in both groups,moreover,which in experimental group was significantly smaller than that in control group（ P〈0. 05）. Moreover the bleeding volume and operation time in experimental group were more than those in control group,but the postoperative drainage tube placement time was significantly shorter than that in control group（ P〈0. 05）. The patients were followed up for 6 months after operation in both groups. The excellent and good rate after operation in experimental group was 70. 83% and the mortality rate was 4. 17%,and which in control group were 46. 67% and 10%,respectively,there were significant differences between the two groups（ P〈0. 05）. Conclusion Neuroendoscopic treatment of thalamic hemorrhage penetrated into cerebral ventricles had the advantages of less trauma,high hematoma clearance rate,good prognosis,therefor,it is worthy of clinical promotion.