神经内镜在丘脑出血破入脑室手术中的应用

Neuroendoscopic surgery for thalamic hemorrhage broken into ventricle

目的探讨神经内镜下早期脑室内血肿清除联合第三脑室底造瘘术(ETV)治疗丘脑出血破入脑室的疗效。方法回顾性分析2011年7月至2015年7月收治的68例丘脑出血破入脑室的临床资料。36例(观察组)行神经内镜血肿清除术联合ETV,术后留置脑室外引流管;32例(对照组)行脑室外引流术(EVD)并联合尿激酶血肿腔注入。术后随访12~26个月,平均(23±2.1)个月。结果观察组有效率(86.1%,31/36)明显高于对照组(62.5%,20/32;P<0.05)。观察组留置脑室外引流管时间([1.8±1.1)d]较对照组([4.8±1.8)d]明显缩短(P<0.05)。观察组术后脑积水发生率(12.9%,5/36)明显低于对照组(37.5%,12/32;P<0.05)。观察组术后颅内感染发生率(0%)与对照组(6.3%)无统计学差异(P>0.05)。两组均未发生过度引流、脑疝、再次出血。结论神经内镜下早期血肿清除联合ETV治疗丘脑出血破入脑室安全有效,可明显降低术后分流依赖性脑积水发生率,显著改善病人预后。

Objective To explore the curative effect of early neuroendoscopic removal of intraventricular hematoma combined with endoscopic third ventriculostomy (ETV) on the thalamic hemorrhage broken into the ventricle.Methods Of 68 patients with thalamic hemorrhage broken into ventricles treated in our department from July,2011 to July,2015,36 (observed group) were treated by neuroendoscopic hematoma removal of intraventricular hematomas combined with ETV and postoperative external ventricular drainage ( EVD),32 (control group) by EVD combined with injection of urokinase into hematoma cavities.All the patients were postoperatively followed up from 12 to 26 months.The curative effects were compared between both the groups.Results The follow-up results showed that the effective rate (86.1%,31/36) was significantly higher in the observed group and that (62.5%,20/32) in the control group (P< 0.05).Conclusion The treatment of thalamic hemorrhage broken into ventricles by neuroendoscopic surgery combined with ETV is safe and effective,because it can significantly reduce the incidence of shunt-dependent hydrocephalus and significantly improve the longterm prognosis in the patients with thalamic hemorrhage broken into ventricles.