基底节区高血压脑出血小骨窗开颅血肿清除术的优势分析

Advantages of keyhole craniotomy for hematoma evacuation in patients with hypertensive basal ganglia hemorrhage

目的探讨基底节区高血压脑出血小骨窗开颅血肿清除术的优势分析。方法选择2017年1月~2018年12月在我院诊断治疗的基底节区高血压脑出血患者60例的临床资料进行回顾性分析。其中30例患者采用小骨窗开颅血肿清除术为小骨窗组,30例患者采用大骨瓣开颅血肿清除术治疗为大骨瓣组。比较两组术后24 h GCS评分、血肿清除率、术后1个月GOS评分、术后6个月Barthel指数、术后并发症情况。结果 (1)两组术后GCS评分没有显著差异(P>0.05),较治疗前有显著提高(P<0.05)。(2)两组术后血肿量均显著低于术前,两组间比较差异无统计学意义(P>0.05);两组血肿清除率比较差异无统计学意义(P>0.05)。(3)术后6个月,小骨窗组Barthel指数评分显著高于大骨瓣组,差异有统计学意义(P<0.05)。(4)小骨窗组术后并发症发生率显著低于大骨瓣组,差异有统计学意义(P<0.05)。结论小骨窗开颅血肿清除术能达到与大骨瓣开颅血肿清除术相似的血肿清除率,但患者术后并发症更少,远期预后更好,可能与其创伤小、对脑组织影响更小等有关。

Objective To investigate the advantages of keyhole craniotomy for hematoma evacuation in patients with hypertensive basal ganglia hemorrhage. Methods In this retrospective study, 60 patients diagnosed as hypertensive basal ganglia hemorrhage in our hospital from January 2017 to December 2018 were selected. Thirty in the keyhole group underwent keyhole craniotomy, and another 30 in the large bone flap group received conventional craniotomy.Glasgow Coma Scale(GCS) scores at 24 h after surgery, clearance rates of hematoma, Glasgow Outcome Scale(GOS)scores at 1 month after surgery, the Barthel index(BI) at 6 months after surgery and the incidence of post-operative complications were compared between the two groups. Results(1)There were no significant differences in post-operative GCS scores between the two groups(P>0.05). However, GCS scores significantly increased after surgery in the two groups compared with the baseline levels(P<0.05).(2)Post-operative hematoma volumes significantly decreased in the two groups com pared with the baseline levels. However, there were no significant differences in hematoma volumes and clearance rates of hematoma between the two groups(P>0.05).(3)BI scores significantly increased in the keyhole group compared with the large bone flap group at 6 months after surgery, with statistically significant differences(P<0.05).(4)The incidence rate of post-operative complications was lower in the keyhole group than that in the large bone flap group, with a statistically significant difference(P<0.05). Conclusion The clearance rate of hematoma after keyhole craniotomy was similar to the rate following large bone flap craniotomy. However, patients undergoing keyhole craniotomy presented a lower incidence rate of post-operative complications and a better long-term prognosis. This may attribute to the limited surgical trauma to the brain in a keyhole craniotomy.