神经内镜手术与小骨窗开颅手术治疗幕上高血压性脑出血的疗效对比分析

Comparison of clinical efficacy of neuroendoscopy and small bone window craniotomy for patients with supratentorial hypertensive intracerebral hemorrhage

目的 对比分析神经内镜手术和小骨窗开颅手术治疗幕上高血压性脑出血(HICH)的疗效。方法 回顾性分析2018年1月~2020年5月手术治疗的166例幕上HICH的临床资料。87例接受神经内镜手术清除血肿(内镜组),79例接受小骨窗开颅手术清除血肿(小骨窗组)。结果 与小骨窗组相比,内镜组手术操作时间明显减少[(65.2±12.2)min vs.(108.3±29.5)min;P<0.001),术中出血量明显减少[(62.8±18.2)ml vs.(196.5±51.5)ml;P<0.001],住院时间明显缩短[(12.7±4.7)d vs.(22.7±4.7)d;P<0.001],术后肺部感染率明显降低[23.0%(22/87)vs. 39.2%(31/79);P<0.05],血肿清除率明显提高[(90.0±2.7)%vs.(82.8±4.0)%;P<0.001],术后3个月预后良好(GOS评分4~5分)率明显增高[57.5%(50/87)vs. 39.2%(31/79);P<0.05]。结论 与小骨窗开颅手术相比,神经内镜手术治疗幕上HICH是一种更好的选择,手术创伤小,术后并发症少,疗效更好。

Objective To compare the clinical efficacy of neuroendoscopic surgery and small bone window craniotomy for patients with supratentorial hypertensive intracerebral hemorrhage(HICH).Methods The clinical data of 166 patients with supratentorial HICH treated by operation from January 2018 to May 2020 were retrospectively analyzed.Of these 166 patients,87 patients underwent neuroendoscopic surgery to remove hematoma(endoscopic group)and 79 patients underwent small bone window craniotomy to remove hematoma(small bone window group).Results The operation time in the endoscopic group was significantly shorter than that in the small bone window group[(65.2±12.2)min vs.(108.3±29.5)min;P<0.001).The intraoperative blood loss in the endoscopic group was significantly less than that in the small bone window group[(62.8±18.2)ml vs.(196.5±51.5)ml;P<0.001].The length of hospital stay in the endoscopic group was significantly shorter than that in the small bone window group[(12.7±4.7)d vs.(22.7±4.7)d;P<0.001].The rate of postoperative pulmonary infection in the endoscopic group was significantly lower than that in the small bone window group[23.0%(22/87)vs.39.2%(31/79)P<0.05].The hemoma clearance rate in the endoscopic group than was significantly higher that in the small bone window group[(90.0±2.7)%vs.(82.8±4.0)%;P<0.001].The rate of good prognosis 3 months after surgery(GOS score of 4~5)in the endoscopic group was significantly higher than that in the small bone window group[57.5%(50/87)vs.39.2%(31/79);P<0.05].Conclusions Compared with small bone window craniotomy,neuroendoscopic surgery is a better choice for supratentorial HICH to remove hematoma,with less trauma,fewer postoperative complications and better efficacy.