神经内镜与微创穿刺手术治疗高血压脑出血的近期效果分析

Analysis of short-term effect of neuroendoscopy and minimally invasive puncture on hypertensive intracerebral hemorrhage

目的分析对比神经内镜手术与微创穿刺手术治疗高血压脑出血的近期效果与预后。方法回顾性连续纳入2017年6月至2019年5月首都医科大学密云教学医院神经外科高血压脑出血住院患者55例,经头部CT确诊为幕上血肿。根据治疗方式的不同,将55例患者分为神经内镜组(24例)和微创穿刺组(31例)。通过比较两组的基线资料、手术相关指标及治疗前与出院时Barthel指数评分的差值,评价两种治疗方式的效果及预后。基线资料包括性别、年龄、血肿量、出血部位(基底节区、脑叶、丘脑)、术前格拉斯哥昏迷量表(GCS)评分、发病至手术治疗的时间等,手术相关指标包括手术时间、术中出血量、血肿清除率、术后再出血、颅内感染。结果(1)两组患者性别、出血部位(基底节区、脑叶、丘脑)、年龄、血肿量、术前GCS评分、发病至治疗时间的差异均无统计学意义(均P>0.05)。(2)微创穿刺组手术时间、术中出血量、血肿清除率均低于神经内镜组,组间差异均有统计学意义[(36±7)min比(150±20)min、(8±3)ml比(184±50)ml、(75.7±10.4)%比(88.5±6.6)%,t值分别为26.820、17.295、5.534,均P<0.01];两组再出血和颅内感染发生率的差异均无统计学意义(均P>0.05)。(3)神经内镜组术前与出院时Barthel指数评分的差值高于微创穿刺组,组间差异有统计学意义[(51±9)分比(42±10)分,t=3.309,P=0.002]。结论神经内镜术在改善患者近期预后方面可能优于微创穿刺术,可尝试用于高血压脑出血患者的手术治疗。

Objective To analyze and compare the short-term effect and prognosis of endoscopic surgery and minimally invasive puncture in the treatment of hypertensive cerebral hemorrhage.Methods From June 2017 to May 2019,55 patients with hypertensive intracerebral hemorrhage who were diagnosed as supratentorial hematoma by computed tomography(CT)were recruited in the Department of Neurosurgery of Miyun Teaching Hospital,Capital Medical University.According to the different treatment methods,55 patients were divided into two groups:neuro-endoscopy group(24 cases)and minimally invasive puncture group(31 cases).The effect and prognosis of the two treatment methods were evaluated by comparing the baseline data,operation-related indexes,and the difference of Barthel index scores between before treatment and at discharge.The baseline data included gender,age,hematoma volume,bleeding site(basal ganglia,lobes,thalamus),preoperative Glasgow Coma Scale(GCS)scores,the time from onset to surgical treatment.The operation related indexes included operation time,intraoperative hemorrhage volume,hematoma clearance rate,postoperative rebleeding,intracranial infection.Results(1)There was no significant difference between the two groups in gender,bleeding site(basal ganglia,lobes,thalamus),age,hematoma volume,preoperative GCS scores and the time from onset to treatment(all P>0.05).(2)The operation time,intraoperative hemorrhage and hematoma clearance rate in the minimally invasive puncture group were all lower than those in the neuro-endoscopy group,and the differences between the two groups were statistically significant([36±7]min vs.[150±20]min,[8±3]ml vs.[184±50]ml,[75.7±10.4]%vs.[88.5±6.6]%,t=26.820,17.295,5.534,respectively,all P<0.01).There was no significant difference in the incidence of rebleeding and intracranial infection between the two groups(all P>0.05).(3)The difference value of Barthel index scores between preoperative and discharge in the neuro-endoscopy group was higher than that in the minimally invasive puncture group,and the difference was statistically significant([51±9]points vs.[42±10]points,t=3.309,P=0.002).Conclusion Neuro-endoscopy may be better than minimally invasive puncture in improving the short-term prognosis of patients,and it could be used in the surgical treatment of hypertensive cerebral hemorrhage.