神经内镜对比显微镜对急性脑出血破入脑室的手术效果研究

A comparative study of neuroendoscopy and microscopy in the treatment of acute cerebral hemorrhage ruptured into the ventricle

目的分析显微镜对比神经内镜下血肿清除对急性脑出血伴脑室破入患者的血肿清除效果。方法回顾性分析2017年1月至2019年1月间在岐山县医院和陕西省核工业二一五医院接受治疗的脑出血合并破入脑室患者80例,其中40例行常规显微镜下脑实质血肿清除术联合脑室钻孔引流手术(对照组),40例行神经内镜辅助下脑室内与脑实质血肿清除联合置管引流(观察组)。比较两组患者的手术时间、脑脊液引流时间、术后7d格拉斯昏迷评分(GCS)和颅内感染情况,同时观察并比较患者术后1d、3d、7d时脑实质和脑室血肿清除率情况。结果观察组患者术后7d的GCS评分为(11.26±2.17)分,明显高于对照组的(8.99±2.14)分,颅内感染率为0、术后带管时间为(3.98±1.84)d,明显低于对照组的7.50%和(6.97±1.72)d,差异均有统计学意义(P<0.05);观察组和对照组患者的手术时间分别为(3.10±1.05)h、(3.26±1.17)h,差异无统计学意义(P>0.05);术后1d、3d、7d,观察组患者脑室内血肿清除率分别为(59.86±9.41)%、(71.08±10.84)%、(84.19±8.65)%,明显高于对照组的(26.18±9.63)%、(51.36±10.60)%、(66.10±8.53)%,差异均有统计学意义(P<0.05);而术后1d、3d、7d两组患者的脑实质血肿清除率比较差异均无统计学意义(P>0.05)。结论临床脑出血破入脑室者行神经内镜下手术可显著提升患者脑室血肿清除率,降低术后脑脊液引流时间和颅内感染率。

Objective To compare the effect of microscopy and neuro-endoscopy on hematoma clearance in patients with acute cerebral hemorrhage ruptured into the ventricle.Methods A retrospective analysis was performed on clinical data of 80 patients with cerebral hemorrhage into the ventricle treated in Qishan County Hospital and Shaanxi Nuclear Industry 215 Hospital from January 2017 to January 2019.Forty patients underwent hematoma evacuation of the brain parenchyma under conventional microscope combined with ventricle drilling and drainage surgery (control group), and 40 patients underwent neuroendoscopy-assisted evacuation of ventricular and parenchymal hemorrhage combined with drainage surgery (observation group).The operation time, cerebrospinal fluid drainage time, 7-day Glasgow Coma Scale (GCS) score, and intracranial infection were compared between the two groups.At the same time, the clearance rate of parenchymal and ventricular hemorrhage was observed and compared at 1 day, 3 days, and 7 days after operation. Results In the observation group, the GCS score was 11.26±2.17 at 7 days after operation, which was significantly higher than 8.99±2.14 in the control group;the intracranial infection rate was 0, and the postoperative tube time was (3.98± 1.84) days, which was significantly lower than corresponding 7.50% and (6.97±1.72) days in the control group;all differences were statistically significant (P<0.05).The operation time in the observation group and the control group were (3.10± 1.05) hours and (3.26±1.17) hours, respectively, and the difference was not statistically significant (P>0.05).Comparison of the ventricular hematoma clearance rate between the observation group and the control group at 1 day after surgery , 3 days after surgery, and 7 days after surgery showed that the observation group was significantly higher than the control group;all differences were statistically significant (P<0.05)(59.86±9.41)% vs (26.18±9.63)%,(71.08±10.84)% vs (51.36± 10.60)%,(84.19±8.65)% vs (66.10±8.53)%.However, there were no significant differences in the clearance rates of parenchymal hemorrhage between the two groups at 1 day, 3 days, and 7 days after operation (P>0.05).Conclusion For patients with cerebral hemorrhage into the ventricle, surgery under neuroendoscope can significantly improve the cerebral hematoma clearance rate, reduce postoperative cerebrospinal fluid drainage time and intracranial infection rate.