导航穿刺治疗17例脑出血致脑疝手术疗效分析

Safety and efficacy of neuronavigation-guided minimally invasive aspiration for 17 patients of supratentorial intracerebral hemorrhage with hernia

目的探讨神经导航辅助脑内血肿穿刺术对幕上高血压性脑出血合并脑疝征象的治疗效果及安全性.方法2015年7月至2018年12月选取山东大学齐鲁医院(青岛)符合纳入标准的33例患者,分成导航辅助微创穿刺组和传统开颅手术组进行血肿清除治疗,比较两组手术时间、血肿清除率及术后并发症发生率.采用格拉斯哥昏迷评分(GCS)对患者的术前及术后第1天神经功能缺损情况进行评估,Modified Rankin Scale(mRS)评分作为患者术后的随访量表,评估患者术后的神经功能康复情况.结果两组患者在基线比较上无差别,在手术持续时间方面,微创穿刺组明显短于开颅组(P<0.01),而开颅组血肿清除率高于微创穿刺组(P<0.01).术后第1天GCS评分差异无统计学意义(P=0.29),6个月后mRS评分差异有统计学意义(P=0.026),在再出血及脑积水并发症发生率方面,两组差异无统计学意义.结论神经导航辅助脑内血肿穿刺治疗幕上合并脑疝征象的脑出血具有操作迅速、安全、神经功能恢复更佳等特点,可以改善患者的预后.

Objective To evaluate the safety and efficacy of neuronavigation-guided aspiration for large supratentorial intracerebral hemorrhage complicated with hernia.Methods A total of 33 patients with supratentorial intracerebral hemorrhage treated during Jul.2017 and Dec.2018 were divided into 2 groups:neuronavigation-guided minimally surgery group(n=17)and craniotomy group(n=16).The operation time,evacuation rate and postoperative complications were compared.The preoperative and postoperative 1d neurological status were evaluated with Glasgow Coma Scale(GCS).The neurological recovery was evaluated with modified Rankin Scale(mRS).Results There were no significant difference in baseline parameters between the 2 groups.The neuronavigation-guided group had significantly shorter operation time but higher evacuation rate than the craniotomy group(P<0.01).There was no difference in postoperative 1d GCS(P=0.29).The mRS score was significantly improved in neuronavigation-guided group 6 months after surgery(P=0.026).There was no significant differences in the incidence of complications such as rehemorrhage and hydrocephalus.Conclusion Neuronavigation-guided minimally invasive aspiration is simple,safe and effective in the treatment of supratentorial intracerebral hemorrhage with hernia.It can facilitate recovery of neurological function and improve patients' prognosis.