立体定向辅助微创血肿清除术与保守治疗在脑基底节区中、小量血肿治疗中的比较研究

Small/medium intracerebral hematoma in the basal ganglia: a comparison study of minimally invasive surgical treatment assisted by stereotaxis technique and conservative treatment

目的探讨立体定向辅助微创血肿清除术与单纯保守治疗2种方式对基底节区中、小量血肿患者临床预后的影响。方法选择山西白求恩医院神经外科自2020年3月至2021年3月收治的64例自发性基底节区脑出血患者进入研究,采用随机数字表法将其分为手术组及保守治疗组2组,其中手术组患者33例,采用立体定向辅助微创血肿清除术治疗;保守治疗组患者31例,采用单纯保守治疗。比较2组患者一般基线资料并随访6个月,比较其术后第7天、1个月及6个月时格拉斯哥预后量表(GOS)评分、修正的Barthel指数(MBI)、改良Rankin量表(mRS)评分,以及并发症发生情况。结果2组患者性别、年龄、出血量等基线资料差异均无统计学意义(P>0.05)。术后第7天时2组患者GOS评分、MBI指数及mRS评分差异均无统计学意义(P>0.05)。术后1个月时2组患者GOS评分、MBI指数及mRS评分差异均存在统计学意义(P<0.05);手术组预后良好率为78.79%(26/33),保守治疗组预后良好率为25.81%(8/31),差异有统计学意义(P<0.05)。术后6个月时2组患者GOS评分、MBI指数及mRS评分差异均存在统计学意义(P<0.05);手术组预后良好率为95.7%(29/33),保守治疗组预后良好率为32.3%(10/31),差异有统计学意义(P<0.05)。手术组及保守治疗组并发症发生率分别为6.06%、29.03%,差异有统计学意义(P<0.05)。结论立体定向辅助微创血肿清除术治疗基底节区中、小量脑出血疗效优于保守治疗。

Objective To investigate the influences of minimally invasive hematoma removal assisted by stereotaxis technique and conservative treatment in clinical prognoses of patients with small/medium intracerebral hematoma in the basal ganglia.Methods Sixty-four patients with spontaneous basal ganglia cerebral hemorrhage,admitted to our hospital from March 2020 to March 2021,were enrolled in our study;these patients were randomly divided into surgical group(accepted minimally invasive hematoma removal assisted by stereotaxis technique,n=33)and conservative treatment group(n=31).The baseline general data and 6 months follow-up data of patients from the 2 groups were compared.The Glasgow outcome scale(GOS)scores,modified Barthel index(MBI),modified Rankin scale(mRS)scores and complications were compared 7 d,1 month and 6 months after surgery.Results There were no significant differences in gender,age,and amount of bleeding between the 2 groups(P>0.05).On the 7th d of surgery,there were no significant differences in GOS scores,MBI,and mRS scores between the 2 groups(P>0.05).One month after surgery,there were statistically significant differences in GOS scores,MBI,and mRS scores between the 2 groups(P<0.05);the good prognosis rate in the surgical group was 78.79%(26/33),and that in the conservative treatment group was 25.81%(8/31),with significant difference(P<0.05).Six months after surgery,there were significant differences in GOS scores,MBI,and mRS scores between the 2 groups(P<0.05);the good prognosis rate in the surgical group was 95.7%(29/33),and that in the conservative treatment group was 32.3%(10/31),with significant difference(P<0.05).The incidence of complications in the surgical group and conservative treatment group was 6.06%and 29.03%,respectively,with significant difference(P<0.05).Conclusion Minimally invasive hematoma removal assisted by stereotaxis technique is more conducive to the repair of nerve function in patients with moderate to small cerebral hemorrhage in the basal ganglia than conservative treatment.