小骨窗联合Viewsite脑牵开器显微手术治疗高血压脑出血的疗效研究

Effect of mi cro-assisted small bone flap craniotomy combined with Viewsite brain retractor on treatment of hypertensive intracerebral hemorrhage

目的探讨显微镜辅助下小骨窗联合Viewsite脑牵开器手术治疗高血压脑出血(HICH)的临床效果。方法选取解放军联勤保障部队第九〇一医院神经外科自2016年6月至2018年6月收治的HICH患者118例,其中53例采用小骨窗联合Viewsite脑牵开器显微手术(微创组),另65例行常规骨瓣开颅、皮质造瘘直视下手术(对照组),对比观察2组患者围手术期相关参数的变化情况及术后并发症,并于6个月后随访进行GOS评分及改良Rankin量表(mRs)神经功能评分。结果与对照组比较,微创组患者手术时间缩短、术中出血量减少、血肿清除率提高、NICU住院时间缩短、术后14dGCS评分提高,而术后气管切开率、术后7d水肿面积及肺部感染均明显降低,差异有统计学意义(P<0.05),而2组侧脑室外引流例数、留置时间、颅内感染率及再出血率比较,差异无统计学意义(P>0.05),术后6个月微创组患者的GOS评分及mRS分级评分均明显优于对照组,差异具有统计学意义(P<0.05)。结论显微镜辅助下小骨窗联合Viewsite脑牵开器手术治疗HICH具有出血创伤小,血肿清除彻底,且术后并发症少等特点,术后神经功能恢复良好,临床疗效显著。

Objective To investigate the clinical effect of micro-assisted small bone flap craniotomy combined with Viewsite brain retractor on treatment of hypertensive intracerebral hemorrhage (HICH). Methods One hundred and eighteen patients diagnosed as HICH admitted to the Department of Neurosurgery,The 901st Hospital of the Joint Logistics Support Force of PLA from June 2016 to June 2018. Among them,53 patients had microsurgery with small bone flap craniotomy combined with Viewsite brain retractor (minimally invasive group),other 65 patients underwent routine craniotomy combined with cortical fistula (control group). The changes of perioperative parameters and postoperative complications were compared between the two groups. GOS score and modified Rankin scale (mRs) neurological function score were followed up 6 months later. Results Compared with the control group,the minimally invasive group had shorter operation time,less intraoperative hemorrhage,higher clearance rate of hematoma,shorter hospitalization time in NICU and higher GCS score at 14 d after operation,while the tracheotomy rate,edema area and pulmonary infection at 7 d after operation were significantly reduced (P<0.05),while the number of lateral ventricular drainage cases and indwelling time,intracranial infection rate and re-bleeding were significantly decreased (P<0.05). There was no significant difference in the rate (P>0.05). The GOS score and mRs score of the minimally invasive group were significantly better than those of the control group 6 months after operation (P<0.05). Conclusion Microscopically assisted small bone window combined with Viewsite brain retractor for HICH has the characteristics of less bleeding and trauma,complete removal of hematoma,and fewer complications. Postoperative neurological function recovery is good,and the clinical effect is remarkable.