神经内镜下治疗基底节区高血压脑出血的效果研究

Effect of neuroendoscopy on hypertensive intracerebral hemorrhage in basal ganglia

目的探讨传统开颅手术与神经内镜手术在治疗基底节区高血压脑出血(HICH)患者中的疗效与安全性,为其临床治疗提供一定依据。方法 86例基底节区HICH患者,根据手术方式不同将患者分为神经内镜组(40例)和开颅手术组(46例),开颅手术组采用开颅血肿清除手术治疗,神经内镜组采用神经内镜微创血肿清除手术治疗,对比两组基底节区HICH患者皮肤切口大小、骨窗大小、皮层切口大小、手术时间、术中出血量、血肿清除率、术后并发症、近期与远期疗效和病死率。结果神经内镜组患者的皮肤切口大小、骨窗大小、皮层切口大小、手术时间、术中出血量均明显低于开颅手术组(P <0.01);两组患者血肿清除率差异无统计学意义(P>0.05);神经内镜组患者术后并发症发生率为10.0%,明显低于开颅手术组的28.3%(P <0.05);神经内镜组患者近期疗效良好率为90.0%明显高于开颅手术组的60.9%(P <0.01);神经内镜组患者远期疗效良好率为92.5%明显高于开颅手术组的63.0%(P <0.01);开颅手术组患者死亡3例,病死率6.5%;神经内镜组患者死亡2例,病死率5.0%;两组患者病死率差异无统计学意义(P>0.05)。结论神经内镜手术治疗基底节区HICH可以减小手术创伤,缩短手术时间,降低出血量,提升近期与远期疗效,降低并发症发生率。

Objective To evaluate the efficacy and safety of traditional craniotomy and endoscopy in the treatment of hypertensive intracerebral hemorrhage in basal ganglia.Methods 86 patients with hypertensive intracerebral hemorrhage in basal ganglia were divided into neuroendoscopy group(n=40)and craniotomy group(n=46).Patients with hypertensive intracerebral hemorrhage in basal ganglia were treated by endoscope minimally invasive hematoma removal.The size of skin incision,bone window,cortical incision,operative time,intraoperative blood loss,hematoma clearance rate,postoperative complications,short-term and long-term outcomes,mortality were compared between the two groups.Results The incision size,bone window size,cortical incision size and operation time of patients with hypertensive intracerebral hemorrhage in basal ganglia were analyzed.The blood loss during operation was significantly lower than that in the craniotomy group(P<0.01),there was no significant difference in hematoma clearance rate between the two groups(P>0.05),and the incidence of postoperative complications in patients with hypertensive intracerebral hemorrhage in the basal ganglia region of the endoscopic group was lower than that in the endoscopic group(P<0.01).10.0%was significantly lower than that in the craniotomy group(P<0.05),90.0%of the patients with hypertensive intracerebral hemorrhage in basal ganglia in the endoscopic group was significantly higher than that in the craniotomy group(60.9%,P<0.01),and the long-term effect of hypertensive intracerebral hemorrhage in the basal ganglia in the endoscopic group was higher than that in the group of craniotomy(P<0.01).The good rate of 92.5%was significantly higher than that of 63.0%in the craniotomy group(P<0.01),and 3 cases died in the craniotomy group.The mortality of patients in the neuroendoscopy group was 5.0.There was no significant difference between the two groups in the mortality of hypertensive intracerebral hemorrhage in basal ganglia(P>0.05).Conclusion Endoscopic neurosurgery for hypertensive intracerebral hemorrhage in basal ganglia area can reduce surgical trauma,shorten operative time,decrease bleeding volume,improve short-term and long-term results,and reduce the incidence of complications.