钻孔引流术与神经内镜下血肿清除术治疗高血压基底节区脑出血术后脑水肿情况比较

Comparison of brain edema after drilling drainage and neuroendoscopic hematoma removal in the treatment of hypertensive basal ganglia intracerebral hemorrhage

目的比较钻孔引流术与神经内镜下血肿清除术治疗高血压基底节区脑出血术后脑水肿情况的差异。方法回顾性分析武汉大学人民医院自2020年1月到2021年12月收治的62例高血压基底节区脑出血患者的临床资料,其中32例接受钻孔引流术治疗(钻孔组),30例接受神经内镜血肿清除术治疗(内镜组)。利用患者在院期间连续性CT或磁共振成像扫描图像,结合3D Slicer软件对水肿区域进行量化计算。比较2组患者手术时间及术后血肿和水肿情况。结果内镜组手术时间长于钻孔组,术后残余血肿体积小于钻孔组,血肿清除率大于钻孔组,差异均有统计学意义(均P<0.05)。内镜组术后水肿峰值体积和水肿体积净增加值均小于钻孔组[(32±11)ml比(38±14)ml、(13±10)ml比(19±12)ml],3~5 d内达水肿峰值体积比例高于钻孔组[66.7%(20/30)比37.5%(12/32)],差异均有统计学意义(均P<0.05)。内镜组9~11 d血肿完全吸收、12~15 d水肿完全消退比例均高于钻孔组,差异均有统计学意义(均P<0.05)。结论与钻孔引流术相比,神经内镜下血肿清除术治疗高血压基底节区脑出血术后脑水肿程度更低。

Objective To compare the difference of brain edema after drilling drainage and neuroendoscopic hematoma removal in the treatment of hypertensive basal ganglia intracerebral hemorrhage.Methods The clinical data of 62 patients with hypertensive basal ganglia hemorrhage admitted to Renmin Hospital of Wuhan University from January 2020 to December 2021 were analyzed retrospectively,including 32 cases treated with drilling drainage(drilling group)and 30 cases treated with neuroendoscopic hematoma removal(endoscopic group).The edema area was quantitatively calculated by continuous CT or magnetic resonance imaging combined with 3 D Slicer software.The operation time,postoperative hematoma and edema were compared between the two groups.Results The operation time in the endoscopic group was longer than that in the drilling group,the volume of postoperative residual hematoma was smaller than that in the drilling group,and the hematoma clearance rate was higher than that in the drilling group(all P<0.05).The peak volume of edema and the net increase of edema volume after operation in the endoscopic group were lower than those in the drilling group[(32±11)ml vs(38±14)ml,(13±10)ml vs(19±12)ml],and the proportion of reaching the peak of edema within 3-5 d was higher than that in the drilling group[66.7%(20/30)vs 37.5%(12/32)](all P<0.05).The rates of complete absorption of hematoma in 9-11 d and complete regression of edema in 12-15 d in the endoscopic group were higher than those in the drilling group(both P<0.05).Conclusion Compared with drilling drainage,the degree of brain edema after neuroendoscopic hematoma removal is lower in the treatment of hypertensive basal ganglia intracerebral hemorrhage.