神经内镜辅助下经胼胝体入路治疗脑室出血的临床疗效分析

Clinical efficacy of surgery via endoscopic-assisted transcallosal approach in intraventricular hemorrhage

目的探讨神经内镜辅助下经胼胝体入路治疗脑室出血(IVH)的疗效及安全性。方法回顾性分析阜阳市人民医院自2016年10月至2020年1月收治的68例IVH患者资料,根据治疗方法将患者分为内镜治疗组(34例)及引流组(34例)。内镜治疗组采用神经内镜辅助下经胼胝体入路清除血肿,引流组采用钻孔引流加尿激酶注射治疗。比较2组患者术后1、3、7 d时血肿大部分清除率(血肿清除率≥95%定义为大部分清除),术后7 d或30 d内并发症发生率,以及术后3个月时预后良好率[日常生活能力量表(ADL)分级Ⅰ~Ⅲ级定义为预后良好]。结果术后1、3、7 d,内镜治疗组患者血肿大部分清除率明显高于引流组,差异均有统计学意义(P<0.05)。内镜治疗组患者术后7 d内颅内再出血率、颅内感染率及术后30 d内因继发性脑积水行分流术患者比例均明显低于引流组(2.9%vs.20.6%、2.9%vs.23.5%、5.9%vs.17.6%),差异有统计学意义(P<0.05)。术后3个月时,内镜治疗组患者预后良好率明显优于引流组(91.2%vs.58.9%),差异有统计学意义(P<0.05)。结论神经内镜辅助下经胼胝体入路治疗IVH可有效改善患者预后并减少并发症,值得临床推广应用。

Objective To investigate the efficacy and safety of surgery via endoscopic-assisted transcallosal approach in intraventricular hemorrhage(IVH).Methods A retrospective study was performed;the clinical data of 68 IVH patients admitted to our hospital from October 2016 to January 2020 were analyzed.These patients were divided into endoscopic treatment group(n=34)and drainage group(n=34)according to the treatment methods.In the endoscopic treatment group,IVH was evacuated via endoscopic-assisted transcallosal approach;in the drainage group,external ventricular drainage and urokinase injection were performed.Gross hematoma clearance rate(clearance rate≥95%)1,3,and 7 d after surgery,complication incidence 7 d and 1 month after surgery,and good prognosis rate(ability of daily living[ADL]grading I-III)3 months after surgery were compared between the two groups.Results One,3,and 7 d after surgery,the gross hematoma clearance rate in the endoscopic treatment group was significantly higher than that in the drainage group(P<0.05).The recurrent hemorrhage rate within 7 d of surgery,intracranial infection rate,and percentage of patients with secondary hydrocephalus requiring shunt within 30 d of surgery in the endoscopic treatment group were significantly lower than those in the drainage group(2.9%vs.20.6%,2.9%vs.23.5%,5.9%vs.17.6%,P<0.05).Three months after follow-up,the good prognosis rate of patients in the endoscopic treatment group was significantly higher than that in the drainage group(91.2%vs.58.9%,P<0.05).Conclusion Endoscopic-assisted transcallosal approach is recommended in clinical treatment of IVH,which can significantly reduce postoperative complications and improve postoperative prognosis.