神经内镜下经额锁孔入路与显微镜下经颞锁孔入路手术治疗基底节区脑出血的疗效比较

Comparison of efficacies of surgeries via frontal keyhole approach assisted by endoscope and via temporal keyhole approach assisted by microscope in treatment of basal ganglia cerebral hemorrhage

目的:通过与显微镜下经颞锁孔入路对比,评价神经内镜下经额锁孔入路治疗基底节区脑出血的临床疗效及安全性。方法:选择苏州大学附属第二医院神经外科自2017年1月至2020年1月行手术治疗的基底节区脑出血患者105例,其中采用神经内镜下经额锁孔入路手术治疗51例(神经内镜组),采用显微镜下经颞锁孔入路手术治疗54例(显微镜组)。回顾性分析患者的临床资料,比较2组患者间血肿清除率、术中出血量、手术时间和住院时间、术后1周格拉斯哥昏迷量表(GCS)评分、术后并发症发生率以及术后6个月日常生活能力评定量表(ADL)评分的差异。结果:2组患者的血肿清除率、住院时间差异均无统计学意义(P>0.05);与显微镜组比较,神经内镜组患者的术中出血量、手术时间明显减少,术后1周GCS评分更高,差异均有统计学意义(P<0.05)。2组患者术后并发症发生率、术后6个月ADL评分的差异均无统计学意义(P>0.05)。结论:显微镜下经颞锁孔入路和神经内镜下经额锁孔入路手术治疗基底节区脑出血均能有效清除颅内血肿,保护神经功能,但神经内镜下手术时间更短,术中出血更少,神经功能开始恢复时间更早。

Objective To compare the clinical efficacy and safety of surgeries via frontal keyhole approach assisted by neuro-endoscope and via temporal keyhole approach assisted by microscope in cerebral basal ganglia hemorrhage.Methods One hundred and five patients with basal ganglia cerebral hemorrhage admitted to our hospital from January 2017 to January 2020 were chosen in our study;51 patients underwent surgeries via frontal keyhole approach assisted by neuro-endoscope(neuro-endoscopy group)and 54 patients underwent surgeries via temporal keyhole approach assisted by microscope(microscopy group).The clinical data of these patients were retrospectively analyzed;and the differences of hematoma clearance rate,intraoperative blood loss,duration of surgery,length of hospital stays,Glasgow Coma Scale(GCS)scores one week after surgery,incidence of postoperative complications,and activity of daily living(ADL)scores 6 months after surgery were compared between the 2 groups.Results There were no significant differences in hematoma clearance rate and length of hospital stays between the 2 groups(P>0.05).As compared with the microscopy group,the neuro-endoscopy group had significantly lower intraoperative blood loss,significantly shorter duration of surgery,and statistically higher GCS scores one week after surgery(P<0.05).There were no significant differences in incidence of postoperative complications and ADL scores 6 months after surgery between 2 groups(P>0.05).Conclusion Both surgeries via frontal keyhole approach assisted by neuro-endoscope and via temporal keyhole approach assisted by microscope can effectively clear the intracranial hematoma in patients with cerebral hemorrhage in the basal ganglia and protect neurological function;however,surgeries via frontal keyhole approach assisted by neuro-endoscope has advantages of shorter duration of surgery and lower intraoperative blood loss,and earlier neurological function recovery.