老年高血压脑出血患者神经内镜下血肿清除术与小骨窗开颅血肿清除术的临床疗效

Neuroendoscopic hematoma removal and small bone window craniotomy for hypertensive intracerebral hemorrhage

目的探讨神经内镜下血肿清除术与小骨窗开颅显微镜下血肿清除术在老年高血压脑出血手术治疗中的临床特点及疗效。方法回顾性分析2014年1月～2017年1月北京市房山区良乡医院神经外科住院的高血压脑出血患者112例,根据手术方式不同分为神经内镜组50例,小骨窗组62例。分别采用神经内镜血肿清除术和小骨窗开颅显微镜下血肿清除术治疗。比较2组患者手术时间、术中出血量、血肿清除率、术后并发症,并对2组患者入院时和术后3个月日常生活活动能力(ADL)及临床神经功能缺损程度(NDS)评分进行比较。结果神经内镜组总有效率明显高于小骨窗组,差异有统计学意义(90.0%vs 83.9%,P<0.05)。神经内镜组手术时间和术中出血量明显少于小骨窗组,血肿清除率明显高于小骨窗组,差异有统计学意义(P<0.05)。小骨窗组和神经内镜组术后3个月ADL评分明显高于入院时,NDS评分明显低于入院时,差异有统计学意义(P<0.05)。神经内镜组术后3个月ADL评分明显高于小骨窗组,NDS评分明显低于小骨窗组,差异有统计学意义(P<0.05)。小骨窗组并发症发生率明显高于神经内镜组,差异有统计学意义(24.2%vs 20.0%,P<0.05)。结论在治疗老年高血压脑出血手术中,神经内镜下血肿清除术明显优于小骨窗开颅显微镜下血肿清除术,缩短手术时间,降低术中出血量,值得临床进一步推广。

Objective To suty the clinical efficacy of neuroendoscopic hematoma removal and small bone window craniotomy in elderly patients with hypertensive intracranial hemorrhage.Methods One hundred and twelve hypertensive intracranial hemorrhage patients admitted to our hospital from January 2014 to January 2017 were divided into neuroendoscopic hematoma removal group (n=50)and small bone window craniotomy group(n=62).They underwent neuroendoscopic hematoma removal and small bone window craniotomy respectively.The operation time,intraoperative blood loss,hematoma clearance rate and postoperative complications,ADL and NDS scores on admission and at month 3 after operation were compared between the two groups.Results The total effective rate was significantly higher in neuroendoscopic hematoma removal group than in small bone window craniotomy group(90.0% vs 83.9%,P<0.05).The operation time was significantly longer,the intraoperative hemorrhage volume was significantly smaller,the hematoma clearance rate was significantly higher in neuroendoscopic hematoma removal group than in small bone window craniotomy group(P<0.05).The ADL score was significantly higher while the NDS score was significantly lower in two groups at month 3 after operation than at admission(P<0.05) and in neuroendoscopic hematoma removal group than in small bone window craniotomy group at month 3 after operation than at admission(P<0.05).The incidence of complications was significantly higher in small bone window craniotomy group than in neuroendoscopic hematoma removal group(24.2% vs 20.0%,P<0.05).Conclusion The clinical efficacy of neuroendoscopic hematoma removal is significantly higher than that of small bone window craniotomy in elderly patients with hypertensive intracerebral hemorrhage.Neuroendoscopic hematoma removal can shorten the operation time,reduce the intraoperational bleeding volume,and is thus worthy of popularization in clinical practice.