神经内镜结合管状牵开器治疗脑室出血的临床效果

Clinical effect of neuroendoscopy combined with tubular retractor in the treatment of intraventricular hemorrhage

目的观察神经内镜结合管状牵开器治疗脑室出血的临床效果。方法选择2015年11月至2018年1月应用神经内镜并在术中结合管状牵开器治疗脑室出血的23例患者为研究对象,分析其疗效及预后。结果术后24 h复查颅脑CT,脑室内血肿绝大部分清除者17例,6例部分清除。术后1周复查颅脑CT,脑室内血肿几乎吸收;术后颅内感染1例,无继发出血发生。术后2个月对患者进行GOS评分评估,5分5例,4分8例,3分4例,2分3例,1分3例(2例死于肺部感染,1例脑疝晚期)。16例患者完成术后半年随访,发现其中13例患者脑室内血肿完全吸收,同时脑室系统形态结构恢复正常状态,3例脑室系统轻微扩大,非脑积水;ADL分级:Ⅰ级3例,Ⅱ级5例,Ⅲ级4例,Ⅳ级3例,V级1例,恢复有效率为75.00%(12/16)。结论临床治疗脑室出血过程中,神经内镜可以在直视条件下操作,脑室内积血的清除速度加快,预后效果理想。术中利用管状牵开器作为内镜进入脑室的支撑通道,可更容易吸除血肿,视野也较单纯内镜下更开阔,对脑室壁的观察更清晰,从而附加的损伤较轻。

Objective To observe the clinical effect of neuroendoscopy combined with tubular retractor in the treatment of intraventricular hemorrhage. Methods From November 2015 to January 2018, 23 patients with intraventricular hemorrhage treated with neuroendoscopy and intraoperative tubular retractor were selected as the study objests, and the efficacy and prognosis of them were analyzed. Results A brain CT examination was conducted at 24 hours after operation, which showed that the intraventricular hematoma was mostly removed in 17 cases and partially removed in the rest 6 cases. A brain CT examination was conducted at 1 week after operation, which showed that the intraventricular hematoma was completely removed in all cases, and there was only 1 case of intracranial infection and no case of further bleeding. All the cases were graded according to the GOS at 2 months after operation, with 5 cases scoring 5 points, 8 cases scoring 4 points, 4 cases scoring 3 points, 3 cases scoring 2 points and 3 cases scoring 1 point(2 cases died due to pulmonary infection and 1 case was late cerebral palsy). Sixteen patients were followed up for half a year after operation and found that 13 cases had complete absorption of intraventricular hematoma and the morphological structure of ventricular system returned to normal;3 patients had slight enlargement of ventricular system and non-hydrocephalus. The ADL grading showed 3 cases of gradeⅠ, 5 cases of grade Ⅱ, 4 cases of grade Ⅲ, 3 cases of grade Ⅳ and 1 case of grade Ⅴ, and the recovery effective rate was 75.00%(12/16). Conclusion Neuroendscopy in the treatment of intraventricular hemorrhage enables doctors to remove the blood directly, rapidly and efficiently, with a positive prognosis. The tubular retractor is used as a support channel for the neuroendoscopy to enter the ventricle during operation, which makes it easier to aspirate the hematoma. The visual field is wider than that of the simple neuroendoscopy, and the observation of the ventricular wall is clearer, so that the additional damage is lighter.