显微镜下经外侧裂入路的血肿清除术治疗高血压脑出血患者的临床效果

Clinical Effect on the Treatment of Hypertensive Intracerebral Hemorrhage by the Removal of Hematoma Via Lateral Fissure Approach Under Microscope

目的研究显微镜下经外侧裂入路的血肿清除术治疗高血压脑出血(HICH)患者的效果。方法选取2018年1月至2020年2月温县人民医院收治的82例HICH患者作为研究对象行回顾性分析。其中,将接受经皮质造瘘血肿清除术治疗的40例患者纳入造瘘组,将接受显微镜下经外侧裂入路的血肿清除术治疗的42例患者纳入外侧裂组。比较两组手术耗时、血肿清除率、手术出血量、住院时间、并发症,以及术前、术后1个月、术后3个月格拉斯哥昏迷量表(GCS)评分。比较两组术前和术后3d血清因子水平,包括轴突生长抑制因子A(Nogo-A)、核因子-κBp65(NF-κB p65)。结果与造瘘组比较,外侧裂组手术出血量减少,住院时间与手术耗时缩短,血肿清除率增加(P<0.05)。术后1、3个月,外侧裂组GCS评分高于造瘘组(P<0.05)。术后3d,两组血清Nogo-A、NF-κBp65水平低于术前,外侧裂组血清Nogo-A、NF-κBp65水平低于造瘘组(P<0.05)。与造瘘组相比,外侧裂组并发症发生率较低(P<0.05)。结论与经皮质造瘘血肿清除术相比较,采用显微镜下经外侧裂入路的血肿清除术治疗HICH患者,可缩短手术耗时,减少出血量,增加血肿清除率,加快康复进程,减轻颅脑损伤,下调血清Nogo-A、NF-κBp65水平,并减少并发症。

Objective To study the clinical effect of hematoma removal via lateral fissure approach under microscope in the treatment of patients with hypertensive intracerebral hemorrhage(HICH).Methods From January 2018 to February 2020,82 patients with HICH admitted to Wenxian People’s Hospital were selected as the research object and analyzed retrospectively.Among them,40 patients who were treated by transcortical ostormy hematoma evacuation were included in fistula group,and 42 patients who were treated by microscopic hematoma evacuation via lateral fissure approach were included in lateral fssure group.The operation time,hematoma clearance rate,blood loss,hospital stay,complications and Glasgow coma scale(GCS)score before operation,one month after operation and three months after operation were compared between the two groups.The levels of serum factors,including neurite outgrowth inhibitor-A(Nogo-A)and nucear factor-κBp65(NF-κBp65)were compared between the two groups before and 3 days after operation.Results Compared with fistula group,the amount of surgical bleeding was less,and the length of hospital stay and operation time were shortened,and the rate of hematoma clearance was increased in lateral fssure group(P<0.05).The GCS score of lateral fssure group was higher than that of fistula groupat 1 and 3 months postoperatively(P<0.05).Three days after operation,the levels of serum Nogo-A and NF-κBp65 in the two groups were lower than those before operation,while those in lateral fissure group were lower than those in fistula group(P<0.05).The complication rate of lateral fssure group was lower than that of fistula group(P<0.05).Conclusion Compared with the removal of hematoma by transcortical fistula,the removal of hematoma by lateral cleft approach under microscope in the treat ment f patients with HICH can shorten the operation time,reduce bleeding,improve the removal rate of hematoma,speed up the process of rehabilitation,reduce craniocerebral injury,lower the levels of serum Nogo-A and NF-κBp65 and reduce complicat ions.