不同微创手术方式治疗自发性脑出血疗效对比:单中心回顾性分析

Effect of minimally invasive surgery for intracerebral hemorrhage:a single center retrospective analysis

目的评估不同微创手术方式治疗自发性脑出血(ICH)的安全性、有效性及长期预后。方法回顾性分析浙江大学医学院附属第二医院神经外科自2019年1月至2020年12月收治的微创手术治疗的356例ICH患者相关资料,根据手术方式的不同,将患者分为内镜组、立体定向组、小骨窗开颅组。分析3组患者的基线资料、围术期以及长期预后情况,评估不同微创手术方式治疗ICH的安全性、有效性。结果本研究共纳入356例患者,其中内镜手术组116例,立体定向组135例,小骨窗开颅组105例。3组患者的年龄、性别、既往病史、出血位置以及术前GCS评分等基线资料比较,差异无统计学意义(P>0.05);内镜组与立体定向组手术时长和术中失血量明显少于小骨窗开颅组,而立体定向组术后再发出血率明显高于其他2组,差异有统计学意义(P<0.05)。内镜组和小骨窗开颅组术后24 h血肿清除率高于立体定向组,内镜组术后3 d血肿清除率优于小骨窗开颅组和立体定向组,差异均具有统计学意义(P<0.05),而小骨窗开颅组与立体定向组比较差异无统计学意义(P>0.05)。术后7 d立体定向组和内镜组NIHSS评分明显低于小骨窗开颅组,预后良好率亦高于小骨窗开颅组;术后6个月内镜组和立体定向组NIHSS评分明显低于小骨窗开颅组,预后良好率高于小骨窗开颅组,差异均具有统计学意义(P<0.05)。结论微创手术方式治疗ICH效果明确,可明显改善患者的长期预后,其中内镜辅助下血肿清除术血肿清除效率高且并发症少。

Objective To evaluated the safety,efficacy and longterm prognosis of different minimally invasive surgery treatments in patient with intracerebral hemorrhage(ICH).Methods Patients with basal ganglia hemorrhage,admitted to Neurosurgery Department of Second Affiliated Hospital,School of Medicine,Zhejiang University from January 2019 to December 2020,were divided into three groups:small bone window craniotomy(SBWC)group,endoscopic surgery(ES)group and stereotactic hematoma aspiration followed by urokinase(SHAU)group.The baseline characteristics,perioperative information and lone-term outcome data of the three groups were analyzed to evaluate the safety and effectiveness of different minimally invasive treatments in the treatment of ICH.Results There were 356 patients in this group,including 116 cases in ES group,135 cases in SHAU group and 105 cases in SBWC group.No significant differences were observed among all three groups the baseline characteristics,including age,sex,hematoma location,GCS score,NIHSS score and hematoma volume(P>0.05).There were significant differences among the three groups with respect to the operative blood loss and operative time(P<0.05).The rebleeding rate in the SHAU groups was significantly higher than in the other two groups(P<0.05).The evacuation rate 24 h after operation in AMWC and ES groups was significantly higher than SHAU group(P<0.05).The evacuation rate 3 d after operation in ES group was better than that in SBWC group and SHAU group(P<0.05),but there was no significant difference between SBWC group and SHAU group(P>0.05).On 7 d after surgery,the NIHSS score in ES and SHAU groups were significantly higher than the AMWC group,the good prognosis rate in ES and SHAU groups were significantly higher than the AMWC group(P<0.05).Six months after surgery,the NIHSS score in ES and SHAU groups were significantly higher than the AMWC group,the good prognosis rate in ES and SHAU groups were significantly higher than the AMWC group(P<0.05).Conclusion Minimally invasive surgery has a definite effect on the treatment of ICH and can significantly improve the long-term outcome.Among them,endoscopic surgery has high hematoma removal efficiency and fewer complications.