经额中回内镜辅助与常规开颅清除基底节区血肿的对比研究

Analysis of the efficacy of refront altrusal assist and open cranial hematoma removal to treat the hemorrhage in the basal ganglia

目的对比经额中回内镜辅助下血肿清除与开颅血肿清除术治疗高血压基底节区出血的疗效,优化高血压脑出血的个性化治疗方案。方法纳入2016-01—2019-09菏泽市立医院神经外科收治的符合入选标准的108例高血压基底节区出血患者,其中68例采用内镜辅助下血肿清除术(内镜组),40例采用开颅血肿清除术(开颅组)。比较两种术式的手术时间、血肿清除率、术后失语、术后1周GCS评分、术后并发症、术后1个月的病死率及术后6个月日常生活活动能力(ADL)的良好率。结果内镜组与开颅组血肿清除率(94.9±2.7)%vs(82.8±5.2)%,P<0.001)、血肿清除时间(66.7±4.4)min vs(173.8±47.5)min,P<0.001)、术后失语(25.0%vs 67.5%)比较差异均有统计学意义。内镜组术后1周GCS评分(11.0±1.2 vs 9.1±1.5,P<0.001)、术后并发症明显低于开颅组,术后6个月ADL良好率高于开颅组,差异均有统计学意义。结论经额中回内镜辅助血肿清除术是治疗高血压基底节区出血安全、有效的方法,能显著改善病人语言功能。

Objective To compare the efficacy of endoscopic assisted with middle frontal gyrus and craniotomy in the treatment of hypertensive basal ganglia hemorrhage,and to optimize the individualized treatment of hypertensive intracerebral hemorrhage.Methods 108 patients with hypertensive basal ganglia hemorrhage who met the inclusion criteria were enrolled in the Department of Neurosurgery of Heze Municipal Hospital from January 2016 to September 2019.Among them 68 cases were treated with endoscopic assisted hematoma clearance(endoscopic group).The operation time,hematoma clearance rate,postoperative aphasia,1 week GCS score,postoperative complications,1 month mortality rate and good rate of ADL 6 months after operation were compared between the two methods.Results There was significant difference on the hematoma clearance rate((94.9±2.7)%in the endoscopy group vs(82.8±5.2)%in the craniotomy group,P<0.01),hematoma clearance time(endoscopy group(66.70±4.45)min vs craniotomy group(173.8±47.5)min,P<0.01),postoperative aphasia(25.0%in endoscopy group and 67.5%in craniotomy group).GCS score at 1 week after operation(11.0±1.2)in the endoscopy group vs(9.1±1.5)in the craniotomy group,P<0.01,and postoperative complications in the craniotomy group were significantly lower than those in the craniotomy group,and the good rate of ADL in the endoscopy group was better than that in the craniotomy group at 6 months after operation.Conclusion Endoscopic assisted hematoma clearance through the middle frontal gyrus is a safe and effective method in the treatment of hypertensive basal ganglia hemorrhage,which can significantly improve the protection of patients’language function.