CT引导下神经内窥镜微创手术治疗高血压脑出血的疗效观察及并发症分析

Observation of curative effect and analysis of complication:CT-guided minimally invasive surgery with neuroendoscopy in treating hypertensive cerebral hemorrhage

目的:观察CT引导下神经内窥镜微侵袭手术治疗高血压脑出血的临床疗效及并发症分析。方法:选取在医院接受手术治疗的76例患者的临床资料,根据手术方式的不同将患者分为观察组(40例)和对照组(36例)。观察组采用CT引导下神经内窥镜微侵袭血肿清除术治疗;对照组采用小骨窗显微镜下血肿清除术治疗。观察比较两组患者术中一般情况、血肿清除率,分别采用美国国立卫生研究院卒中量表(NIHSS)、简易智能精神状态检查(MMSE)量表和Barthel指数(BI)评定患者神经功能、恢复情况和日常生活能力,比较两组并发症发生率。结果:观察组在手术时间、术中出血量、皮肤切口长度、骨窗直径大小及住院时间上均显著低于对照组,差异有统计学意义(t=13.567,t=15.719,t=12.896,t=6.704,t=4.303;P<0.05);但两组血肿清除率比较,差异无统计学意义(t=0.467,P>0.05);观察组术后BI评定日常生活能力良好率为72.5%,高于对照组(44.4%),其差异有统计学意义(x^2=6.175,P<0.05);观察组术后2周和1年NIHSS评分均显著低于对照组,其差异有统计学意义(t=2.656,t=3.222;P<0.05);观察组术后2周和1年MMSE评分均显著高于对照组,其差异有统计学意义(t=3.179,t=2.308;P<0.05);观察组并发症发生率为12.5%,显著低于对照组(33.3%),其差异有统计学意义(x^2=4.736,P<0.05)。结论:CT引导下神经内窥镜微侵袭术与显微镜下血肿清除术相比,用时更短、手术创伤更小且术后疗效更佳,可明显降低术后并发症发生。

Objective:To observe the clinically curative effects and analysis of complication of CT-guided minimally invasive surgery with neuroendoscopy in treating hypertensive cerebral hemorrhage.Methods:Seventy-six patients who underwent surgery of hypertensive cerebral hemorrhage in hospital were selected.They were divided into observation group(40 cases)and control group(36 cases)according to the different surgical mode.The patients of observation group were treated by using CT-guided minimally invasive evacuation of hematoma with neuroendoscopy,and these of control group were treated by using evacuation of hematoma under microscopy with small bone window.The general condition and hematoma clearance rate of two groups were observed and compared.And National Institute of Health stroke scale(NIHSS),mini-mental state examination(MMSE)and Barthel index(BI)were respectively adopted to evaluate neurological function,recovery condition and activity of daily living of patients,and the occurrence rate of complication of two groups were compared further.Results:The observation group was significantly lower than the control group in terms of operation time,intraoperative blood loss,skin incision length,bone window diameter and hospitalization time(t=13.567,t=15.719,t=12.896,t=6.704,t=4.303,P<0.05).However,there was no statistical difference in hematoma clearance rate between the two groups(t=0.467,P>0.05).The favorable prognosis rate of observation group(72.5%)was significantly higher than that of control group(44.4%)(x^2=6.175,P<0.05).The NIHSS scores of observation group were significantly lower than those of control group at postoperative 2 weeks and postoperative 1 year(t=2.656,t=3.222,P<0.05),respectively.The MMSE scores of observation group at postoperative 2 weeks and postoperative 1 year were significantly higher than those of control group(t=3.179,t=2.308,P<0.05),respectively.The occurrence rate of complication of observation group(12.5%)was significantly lower than that of control group(33.3%)(x^2=4.736,P<0.05).Conclusions:Compared with evacuation of hematoma under microscopy with small bone window,CT-guided minimally invasive evacuation of hematoma with neuroendoscopy has shorter operative time,less surgical trauma and better postoperative curative effect,and it can significantly reduce the occurrence of postoperative complications.