经额锁孔内镜下治疗高血压性基底节区脑出血的临床效果

Clinical effect of frontal keyhole endoscopy in the treatment of hypertensive basal ganglia intracerebral hemorrhage

目的探讨经额部锁孔开颅神经内镜下治疗高血压性基底节区脑出血的有效性和安全性。方法回顾性分析2019年1月至2020年12月华中科技大学协和深圳医院神经外科收治的40例基底节区脑出血患者的临床资料,依据治疗方法分为观察组与对照组,各20例。观察组采用神经内镜辅助下经额锁孔开颅血肿清除术,对照组采用显微镜下开颅血肿清除术。记录两组患者的围手术期指标和并发症发生情况,术后随访6个月采用格拉斯哥预后量表(GOS)评估患者的预后。结果观察组患者的手术时间短于对照组,术中出血量和术后残余量均少于对照组,血肿清除率高于对照组,差异均有统计学意义(P<0.05)。观察组的术后并发症发生率低于对照组[5.0%(1/20)vs.35.0%(7/20)],差异有统计学意义(χ2=5.630,P<0.05)。两组术后6个月均无死亡病例,观察组术后6个月的预后良好率高于对照组[85.0%(17/20)vs.60.0%(12/20)],差异有统计学意义(χ2=7.35,P<0.05)。结论经额部锁孔开颅神经内镜下治疗高血压性基底节区出血有效且术式微创,血肿清除率高,并能改善高血压性基底节区出血患者的预后,值得推广。

Objective To investigate the effectiveness and practicability of neuroendoscopy through frontal keyhole craniotomy in the treatment of hypertensive basal ganglia intracerebral hemorrhage.Methods The clinical data of 40 patients with basal ganglia intracerebral hemorrhage treated in the Department of Neurosurgery of Xiehe Shenzhen Hospital of Huazhong University of Science and Technology from January 2019 to December 2020 were analyzed retrospectively.According to the treatment methods,they were divided into the observation group and the control group,with 20 cases in each group.The observation group was treated with neuroendoscope assisted transfrontal keyhole craniotomy,and the control group was treated with microscopical craniotomy.The perioperative indexes and complications of the two groups were recorded.The patients were followed up for 6 months,the prognosis was evaluated by Glasgow outcome scale(GOS).Results The operation time of the observation group was shorter than that of the control group,the amount of intraoperative blood loss and postoperative residual volume of the observation group were less than those of the control group,and the hematoma clearance rate of the observation group was higher than that of the control group,the differences were all statistically significant(P<0.05).The incidence of postoperative complications in the observation group was lower than that in the control group(5.0%[1/20]vs.35.0%[7/20]),the difference was statistically significant(χ2=5.630,P<0.05).There was no death in the two groups at 6 months after operation,and the good prognosis rate in the observation group was higher than that in the control group(85.0%[17/20]vs.60.0%[12/20]),the difference was statistically significant(χ2=7.35,P<0.05).Conclusion Neuroendoscopy through frontal keyhole craniotomy is effective and minimally invasive in the treatment of hypertensive basal ganglia intracerebral hemorrhage,with high hematoma clearance rate,and can improve the prognosis of patients,which is worthy of promotion.