神经导航辅助神经内镜下老年高血压脑出血清除术与微创血肿穿刺外引流的效果分析

Comparative analysis on the clinical efficacy of neuronavigation-assisted neuroendoscopic hematoma removal and minimally invasive puncture and external drainage of hematoma in elderly patients with hypertensive cerebral hemorrhage

目的对比分析神经导航辅助神经内镜下老年高血压脑出血血肿清除术与微创血肿穿刺外引流的临床效果。方法选择2017年1月至2018年12月广东三九脑科医院收治的33例高血压脑出血老年患者,根据手术方式不同分为A组和B组,其中A组15例,B组18例。A组采用神经内镜联合导航清除血肿,B组采用导航下钻孔穿刺血肿。比较两组手术时间、术中出血、住院费用、术后监护天数、颅内血肿清除率、预后情况。结果A组的术后监护天数少于B组,A组的颅内血肿清除率高于B组,A组的总住院费用少于B组,并且A组术后3个月、6个月的Barthel指数明显高于B组,差异有统计学意义(P<0.05);但B组手术时间、术中出血量明显少于A组,差异有统计学意义(P<0.05)。结论神经导航辅助神经内镜治疗老年性高血压脑出血能提高疗效,减少住院时间和改善预后;导航下血肿微创穿刺手术时间短、术中出血少,两者手术效果均安全可行。临床上应具体根据患者实际情况,灵活选择手术方案。

Objective To comparatively analyze the clinical efficacy of neuronavigation-assisted neuroendoscopic hematoma removal and minimally invasive puncture and external drainage of hematoma in elderly patients with hypertensive cerebral hemorrhage.Methods A total of 33 elderly patients with hypertensive cerebral hemorrhage admitted to Guangdong 999 Brain Hospital from January 2017 to December 2018 were included and divided into group A and group B according to different surgical methods,with 15 cases in group A and 18 cases in group B.Group A underwent neuronavi gation-assisted neuroendoscopy for hematoma removal,while group B underwent neuronavigation-assisted trephining puncture for hematoma removal.The two groups were compared in terms of the operating time,intraoperative bleeding volume,hospitalization cost,postoperative monitoring days,clearance rate of intracranial hematoma,and prognosis.Results The number of postoperative monitoring days in group A was less than that in group B,the clearance rate of intracranial hematoma in group A was higher than that in group B,the total hospitalization cost in group A was less than that in group B,and the Barthel index in group A was significantly higher than that in group B at 3 and 6 months after surgery,all with statistically significant differences(P<0.05).However,the operating time and intraoperative bleeding volume in group B were significantly shorter/less than those in group A,with statistically significant differences(P<0.05).Conclusion In treatment of the elderly patients with hypertensive cerebral hemorrhage,the neuronavigation-assisted neuroendoscopy can help to improve the efficacy,shorten the hospital stay and improve the prognosis,and at the same time,the neuronavigation-assisted minimally invasive hematoma puncture also has advantages such as short operating t ime and less intraoperative bleeding,indicating that both surgical methods are safe and feasible.Clinically,the surgical plan should be chosen flexibly according to the actual situation of the patients.