神经内镜微创手术与显微镜辅助骨瓣开颅术治疗高血压脑出血的疗效对比

Application of neuroendoscopic minimally invasive surgery and microscope assisted bone flap craniotomy in the treatment of hypertensive intracerebral hemorrhage

目的探讨神经内镜微创手术与显微镜辅助骨瓣开颅血肿清除手术治疗高血压脑出血的疗效。方法纳入2017-01—2020-05蚌埠医学院第二附属医院收治的高血压脑出血患者64例,其中观察组29例,对照组35例。观察组实施神经内镜微创手术治疗,对照组实施显微镜辅助骨瓣开颅血肿清除手术。统计2组手术时间、术中出血量、血肿清除率、非计划二次手术、术后1 d及7 d GCS评分、住院时间、术后并发症及GOS评分。结果所有病例均随访3个月。观察组手术时间、术中出血量及住院时间与对照组比较差异有统计学意义(P<0.05)。观察组血肿清除率与对照组比较无明显差异(P>0.05)。观察组非计划二次手术发生率为6.8%,对照组为11.4%,2组比较差异无统计学意义(P>0.05),术后7 d GCS评分差异有统计学意义(P<0.05)。观察组术后常见并发症发生率13.8%,对照组为37.1%,差异有统计学意义(P<0.05)。观察组良好预后率48.3%,明显高于对照组20.0%,差异有统计学意义(P=0.02)。结论神经内镜微创手术在高血压脑出血治疗中能够缩短手术时间,减少术中出血量及术后并发症,改善患者预后。

Objective To investigate the curative effect of neuroendoscopic minimally invasive surgery and microscopically as⁃sisted craniotomy with bone flap in the treatment of hypertensive intracerebral hemorrhage.Methods A total of 64 patients with hyper⁃tensive intracerebral hemorrhage admitted to the Second Affiliated Hospital of Bengbu Medical College from January 2017 to May 2020 were selected,29 cases in the observation group and 35 cases in the control group.The observation group was treated with neuroendoscopic minimally invasive surgery,while the control group was treated with microscope assisted craniotomy.The operation time,intraoperative blood loss,hematoma clearance rate,unplanned second operation,GCS score of 1 day and 7 days after operation,length of hospital stay,postoperative complications and GOS score were recorded.Results All patients were followed up for 3 months.The operation time,intra⁃operative blood loss and hospital stay were significantly different between the observation group and the control group.There was no signifi⁃cant difference in hematoma clearance rate between the observation group and the control group.The incidence of unplanned second oper⁃ation in the observation group was 6.8%,while that in the control group was 11.4%,with no statistical significance(P>0.05).Seven days after operation,the GCS score was statistically significant(P<0.05).The incidence of postoperative common complications was 13.8%in the observation group and 37.1%in the control group(P<0.05).The good prognosis rate of the observation group was 48.3%,which was significantly higher than that of the control group by 20.0%,the difference was statistically significant(P=0.02).Conclusion Neu⁃roendoscopic minimally invasive surgery in the treatment of hypertensive intracerebral hemorrhage can shorten the operation time and re⁃duce the amount of bleeding,can reduce postoperative complications and improve the prognosis of patients,which is worthy of clinical pro⁃motion.