内镜血肿清除术与钻孔引流术治疗高血压基底节出血的对比研究

Comparison of Therapeutic Effect between Endoscopic Evacuation and Burr Hole Evacuation of Hypertensive Basal Ganglia Hematoma

目的比较2种微创手术方法治疗高血压基底节出血的疗效。方法对80例高血压基底节出血患者进行随机对照研究,40例采用内镜血肿清除术,40例采用钻孔引流术、术后辅助尿激酶纤溶治疗并引流,手术均使用神经导航进行定位指导,比较其疗效。结果按血肿量40 mL为限分为2个组,血肿量小于40 mL为Ⅰ组,血肿量大于或等于40 mL为Ⅱ组,两组疗效无显著性差异(P>0.05),术后第1、3、7天,Ⅰ、Ⅱ组钻孔术组血肿清除率分别为(52.18±15.74)%vs.(40.55±15.35)%、(70.95±13.33)vs.(58.57±14.49)%、(74.50±19.05)%vs.(71.48±5.11)%,Ⅱ组内镜术组疗效优于钻孔术组(均P<0.05)。结论 2种微创手术方式均能有效清除血肿,针对较大血肿,应优先考虑内镜血肿清除术。

Objective To compare the effect of two minimally invasive methods on the treatment of hypertensive basal ganglia hemorrhage.Methods A randomized controlled study of 80 patients with hypertensive basal ganglia hemorrhage was carried out.Forty patients were treated with endoscopic hematoma evacuation,40 patients were operated by burr hole drilling and drainage with aid of urokinase injection,and the operation was guided by the neuronavigation and the therapy effect was compared.All patients were divided into two subgroups according to the volume of hematoma,subgroup I with volume above 40 mL and subgroup Ⅱ with volume below 40 mL.Results The results showed that there was no significant difference between the two groups(P>0.05),while the clearance rate of endoscopic hematoma with hematoma volume of more than 40 mL was better than that of the burr hole drilling.The clearance rate of two subgroups 1 day,3 days and 7 days after surgery was(52.18±15.74)% vs.(40.55±15.35)%,(70.95±13.33)% vs.(58.57±14.49)%,and(74.50±19.05)% vs.(71.48±5.11)%,respectively(P<0.05).Conclusion Two minimally invasive surgical methods can effectively evacuate hematoma.For patients with large hematoma,endoscopic hematoma removal should be given in priority.