小骨窗经额入路显微镜下清除原发性重型脑室出血的临床分析

Clinical study on the treatment of primary severe intraventricular hemorrhage by keyhole transfrontal approach by microscope

目的探讨小骨窗经额入路显微镜下清除原发性重型脑室出血的临床疗效。方法回顾性分析淮南市第一人民医院自2009年10月至2019年10月经手术治疗的成人原发性重型脑室出血患者的临床资料,根据手术方式分为经额入路组及脑室外引流组,对比分析两组患者在年龄、性别、术前GCS评分、Graeb评分、术后24h内血肿清除率、引流管留置时间、术后颅内感染率、晚期脑积水发生率、术后再出血发生率、预后评分等方面差异。结果纳入患者52例,经额入路者15例,脑室外引流者37例。两组患者在年龄、性别、术前GCS评分、Graeb评分、术后感染率、术后再出血发生率的差异上无统计学意义(P>0.05);术后24 h血肿清除率、置管时间、晚期脑积水发生率及预后等方面,经额入路组明显优于脑室外引流组,差异具有统计学意义(P<0.05)。结论与脑室外引流术相比,小骨窗经额入路显微镜下清除原发性重型脑室出血能有效提高疗效、降低远期并发症及改善预后等优势。

Objective To evaluate the efficacy of keyhole approach transfrontal by microscope to remove primary severe ventricular hemorrhage.Methods The clinical data of adult patients with primary severe ventricular hemorrhage treated by surgery from Huainan First People’s Hospital from October 2009 to October 2019 were retrospectively analyzed.According to the operation method,the patients were divided into transfrontal group and external ventricular drainage group.The indexs were analyzed,including age,gender,preoperative GCS score,Graeb score,hematoma clearance rate within 24 hours after operation,drainage tube retention time,postoperative intracranial infection rate,incidence of late hydrocephalus,the incidence of post-rebleeding and prognostic score.Results A total of 52 patients were included,including 15 through the frontal approach and 37 through external ventricular drainage.There was no significant difference in age,gender,preoperative GCS score,Graeb score,postoperative infection rate,and postoperative rebleeding rate between the two groups of patients(P>0.05);The difference between the transfrontal group and the external ventricular drainage group on hematoma clearance rate,tube insertion time,the incidence of hydrocephalus and prognostic score was statistically significant(P<0.05).Conclusion Compared with external ventricular drainage,the transfrontal approach can effectively improve the efficacy,reduce complications and improve the outcome of primary severe ventricular hemorrhage.