内镜手术治疗基底节区高血压脑出血的效果观察

Observation on the effects of endoscopic surgery in the treatment of hypertensive cerebral hemorrhage in basal ganglia region

目的探讨内镜手术治疗基底节区高血压脑出血的效果。方法选择2018年7~12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例患者采用神经内镜下手术治疗为内镜组,30例患者采用小骨窗手术治疗为对照组。比较两组的手术时间、术后残余血量、血肿清除率、再出血率、术前及术后24 h GCS评分,术后6个月GOS预后评价。结果(1)内镜组手术时间显著短于对照组,残余血肿量显著低于对照组,血肿清除率显著高于对照组,差异有统计学意义(P<0.05);两组再出血率比较,差异无统计学意义(P>0.05)。(2)两组治疗后24 h GCS评分较治疗前显著提高,差异有统计学意义(P<0.05);治疗后内镜组GCS评分显著高于对照组,差异有统计学意义(P<0.05)。(3)秩和检验显示,内镜组GOS预后评价显著优于对照组,差异有统计学意义(P<0.05)。结论内镜下手术治疗基底节区高血压脑出血操作相对简单,创伤更小,术中出血量少,血肿清除率高,术后24 h GCS评分更好,术后6个月GOS评分更好,说明该方法创伤小,血肿清除率高,术后近期及远期预后更好。

Objective To investigate the effects of endoscopic surgery in the treatment of hypertensive cerebral hemorrhage in basal ganglia region.Methods Retrospective analysis was conducted on the clinical data of 60 patients with hypertensive cerebral hemorrhage in basal ganglia region diagnosed and treated in our hospital from July to December 2018.Among which,30 patients were treated with neuroendoscopic surgery as the endoscopic group,while 30 patients were treated with small bone window surgery as the control group.Operation time,postoperative residual blood volume,hematoma clearance rate,rebleeding rate,GCS scores before and 24 h after surgery,GOS prognosis evaluation(6 months after surgery)were compared between the two groups.Results(1)Compared with the control group,the operation time in the endoscopic group was significantly shorter,the amount of residual hematoma was significantly lower,and the hematoma clearance rate was significantly higher,the differences were statistically significant(P<0.05);There was no statistically significant difference in rebleeding rate between the two groups(P>0.05).(2)At 24 h after treatment,GCS scores in the two groups were significantly higher than those before treatment,the difference was statistically significant(P<0.05);After treatment,GCS score in the endoscopic group was significantly higher than that in the control group,the difference was statistically significant(P<0.05).(3)The rank-sum test showed that the GOS prognosis evaluation in the endoscopic group was significantly better than that in the control group,the difference was statistically significant(P<0.05).Conclusion Endoscopic surgery in the treatment of hypertensive cerebral hemorrhage in basal ganglia region has relatively simple operation,less trauma,less intraoperative bleeding volume,higher hematoma clearance rate,better GCS score 24 h after surgery,and better GOS score 6 months after surgery,indicating that this method has less trauma,higher hematoma clearance rate,and better short-term and long-term postoperative prognosis.