神经内镜微创手术与小骨窗开颅显微手术治疗幕上高血压脑出血的效果对比

Comparison of Neuroendoscopic Minimally Invasive Surgery and Small Bone Window Craniotomy for Supratentorial Hypertensive Cerebral Hemorrhage

目的研究幕上高血压脑出血神经内镜微创手术与小骨窗开颅显微手术的治疗效果。方法选择2020年6月—2022年5月在邳州市中医院接受手术治疗的58例幕上高血压脑出血患者为研究对象,依据随机数表法分为两组,对照组(29例,小骨窗开颅显微手术治疗)、观察组(29例,神经内镜微创手术治疗)。对比两组间围术期指标、血肿清除率、手术并发症发生率及神经因子(NSE)。结果观察组手术时间、术中出血量、ICU住院时间为(97.20±12.44)min、(62.05±10.55)mL、(6.96±1.23)d,均优于对照组的(125.92±15.48)min、(322.70±16.52)mL、(11.87±2.21)d,血肿清除率为(85.46±9.41)%,高于对照组的(76.85±7.12)%,差异有统计学意义(t=7.788、71.610、10.454、3.929,P<0.05)。观察组并发症发生率(6.90%)低于对照组(27.59%),差异有统计学意义(χ^(2)=4.350,P<0.05)。治疗后,观察组NSE水平低于对照组,差异有统计学意义(P<0.05)。结论较小骨窗开颅显微手术,神经内镜微创手术在幕上高血压脑出血治疗中的效果更为显著,且安全性高。

Objective To study the therapeutic effect of neuroendoscopic minimally invasive surgery with small bone window craniotomy for supratentorial hypertensive cerebral hemorrhage.Methods Fifty-eight patients with supratentorial hypertensive intracerebral hemorrhage who received surgical treatment in Pizhou Hospital of Traditional Chinese Medicine from June 2020 to May 2022 were selected as the study subjects.According to the method of random number table,they were divided into two groups:control group(29 cases,small bone window craniotomy microsurgery)and observation group(29 cases,neuroendoscopic minimally invasive surgery).Perioperative indexes,hematoma clearance rate,operative complication rate and neurologic factor(NSE)were compared between the two groups.Results Operation time,intraoperative blood loss,ICU stay time of observation group were(97.20±12.44)min,(62.05±10.55)mL,(6.96±1.23)d,which were better than(125.92±15.48)min,(322.70±16.52)mL and(11.87±2.21)d of the control group.The hematoma clearance rate was(85.46±9.41)%,which was higher than that of the control group(76.85±7.12)%,the difference was statistically significant(t=7.788,71.610,10.454,3.929,P<0.05).The complication rate of observation group(6.90%)was lower than that of control group(27.59%),and the difference was statistically significant(χ^(2)=4.350,P<0.05).The NSE level in the observation group was lower than that in the control group after treatment,and the difference was statistically significant(P<0.05).Conclusion Compared with small bone window craniotomy,neuroendoscopic minimally invasive surgery is more effective and safe in the treatment of supratentorial hypertensive cerebral hemorrhage.