联合术前精准定位的神经内镜手术治疗自发性基底核区出血的临床疗效分析

Clinical study of application of preoperative precise localization in neuroendoscopic surgery for spontaneous basal ganglia hemorrhage

目的探讨术前精准定位在神经内镜手术治疗自发性基底核区出血中的作用。方法回顾性分析2015年5月至2019年5月福建省立医院南院神经外科手术治疗的50例自发性基底核区出血患者的临床资料。其中25例术前采用自主研发的血肿定位贴精准定位后行神经内镜手术治疗(简称神经内镜组);25例采用传统开颅显微镜手术治疗(简称开颅组)。分析比较两组患者的手术情况(包括手术时长、术中出血量及血肿清除率)、美国国立卫生研究院卒中量表(NIHSS)评分、术后并发症的发生率、住院时间以及术后6个月的格拉斯哥预后评级(GOS)的评估情况。结果两组患者的性别、年龄、术前出血量、发病至手术时间及术前NIHSS评分比较差异均无统计学意义(均P>0.05)。神经内镜组与开颅组比较,手术时长分别为(1.8±0.2)h、(2.4±0.3)h;术中出血量分别为(60.1±5.0)ml、(90.1±7.1)ml;血肿清除率分别为(95.4±4.8)%、(80.4±8.7)%,两组的差异均有统计学意义(均P<0.001)。术后1周两组患者的NIHSS评分均低于术前(均P<0.001);术后1周神经内镜组与开颅组患者的NIHSS评分分别为(12.0±2.4)分、(14.2±2.1)分,两组比较差异无统计学意义(P>0.05);神经内镜组与开颅组患者的住院时间分别为(12.0±1.2)d、(14.1±1.0)d,两组比较差异有统计学意义(P<0.001)。两组患者的术后并发症发生率、术后6个月的GOS比较差异均无统计学意义(均P>0.05)。结论对于自发性基底核区出血,与开颅显微镜手术比较,经术前精准定位后行神经内镜手术可缩短手术时间,减少术中出血量,提高血肿清除率。

Objective To investigate the clinical application of preoperative precise localization in neuroendoscopic surgery for spontaneous basal ganglia hemorrhage(SBGH).Methods The clinical data of 50 patients with SBGH treated with neurosurgery at Department of Neurosurgery,Southern Hospital of Fujian Provincial Hospital from May 2015 to May 2019 were retrospectively analyzed.Among them,25 cases underwent neuroendoscopic surgery following precise preoperative positioning(referred to as neuroendoscopic group)and 25 cases were treated with traditional craniotomy microsurgery(referred to as craniotomy group).The operative conditions(including operation time,intraoperative blood loss and hematoma clearance rate),National Institutes of Health Stroke Scale(NIHSS)score,incidence of postoperative complications,length of hospital stay and Glasgow Outcome Scale(GOS)scores in the two groups were analyzed and compared.Results There were no significant differences in gender,age,time from onset to operation,intraoperative blood loss or preoperative NIHSS score between the two groups(all P>0.05).In the neuroendoscopy group and craniotomy group,the operation time durations were 1.8±0.2 h and 2.4±0.3 h respectively;the intraoperative blood losses were 60.1±5.0 ml and 90.1±7.1 ml respectively;the hematoma clearance rates were(95.4±4.8)%and(80.4±8.7)%respectively;those differences between the two groups were statistically significant(all P<0.001).The NIHSS scores in the two groups at 1 week post operation were lower than those before operation(both P<0.001).The NIHSS scores in the neuroendoscopy group and craniotomy group were 12.0±2.4 points and 14.2±2.1 points respectively,and there was no significant difference between the two groups(P>0.05).In the neuroendoscopy and craniotomy groups,the hospitalization durations were 12.0±1.2 d and 14.1±1.0 d respectively,and the difference between the two groups was statistically significant(P<0.001).There was no significant difference in the incidence of postoperative complications or GOS score at 6 months post operation between the two groups(both P>0.05).Conclusion For SBGH,neuroendoscopic surgery performed following precise preoperative localization could shorten the operation duration,reduce intraoperative blood loss and improve the hematoma clearance rate.