神经内镜手术治疗早期高血压性基底核区出血的临床疗效分析

Clinical efficacy analysis of neuroendoscopic aspiration for early hypertensive hemorrhage in the basal ganglia

目的探讨神经内镜手术治疗早期高血压性基底核区出血的有效性及安全性。方法回顾性分析2016年3月至2019年3月张家口市第一医院神经外科手术治疗90例早期高血压性基底核区出血患者的临床资料。其中采用神经内镜手术47例(简称神经内镜组)、显微镜下开颅手术43例(简称开颅组)。分析比较两组患者在手术时长、术中出血量、术后血肿清除率、并发症(颅内感染)的发生情况以及术后6个月的改良Rankin量表评分(mRS)等方面的差异。结果神经内镜组与开颅组相比,手术时长明显缩短[分别为(93.5±10.7)h、(193.1±15.4)h]、术中出血量显著减少[分别为(30.9±5.8)ml、(119.0±17.9)ml]、血肿清除率明显提高[分别为(96.8±4.5)%、(88.3±6.2)%](均P<0.05)。术后颅内感染的发生率,神经内镜组与开颅组比较差异无统计学意义(P>0.05)。术后6个月的mRS评估比较,神经内镜组的预后良好率(25.5%,12/47)高于开颅组(11.6%,5/43),两组比较差异具有统计学意义(P<0.05)。结论神经内镜手术治疗早期高血压性基底核区出血具有视野清晰、直视性强、创伤小、手术时间短和预后良好等优点,是治疗高血压性基底核区出血安全、有效的手术方式。

Objective To explore the clinical effects and safety of neuroendoscopic aspiration of early hypertensive hematoma in the basal ganglia(EHHBG).Methods A retrospective analysis was conducted on the clinical data of 90 patients with EHHBG who underwent surgical treatment at Department of Neurosurgery,Zhangjiakou First Hospital from March 2016 to March 2019.Among them,neuroendoscopic surgery was performed in 47 cases and microscopic surgery in 43.Differences were compared between the two groups in operative duration,intraoperative blood loss,clearance rate of hematoma,incidence of complication(intracranial infection)and scores of modified Rankin Scale(mRS)at 6 months post operation.Results Compared with microscopic surgery group,neuroendoscopic surgery group had shorter operative duration(93.5±10.7 h vs.193.1±15.4 h,P<0.05)and less intraoperative blood loss in operation(30.9±5.8 ml vs.119.0±17.9 ml,P<0.05)and elevated clearance rate of hematoma[(96.8±4.5)%vs.(88.3±6.2)%,P<0.05],and there were statistical differences between those two groups(all P<0.05).There was no significant difference in the rate of postoperative intracranial infection between two groups(P>0.05).In terms of mRS at 6 months post operation,the rate of favorable outcome in neuroendoscopic surgery group was better than that in microscopic surgery group with significant difference[25.5%(12/47)vs.11.6%(5/43),P<0.05].Conclusion Neuroendoscopic removal of EHHBG has the advantages of clear and direct vision,little invasiveness,short operation time and good prognosis,and is a safe and effective surgical method for cerebral hemorrhage in the basal ganglia.