小骨窗开颅血肿清除术与神经内镜下经外侧裂入路血肿清除术治疗高血压脑出血疗效对比

Comparison of curative effect of small bone window craniotomy hematoma removal and neuroendoscopic hematoma removal via lateral fissure approach on hypertensive intracerebral hemorrhage

目的探讨小骨窗开颅血肿清除术与神经内镜下经外侧裂入路血肿清除术治疗高血压脑出血(HICH)患者的疗效及安全性。方法回顾性分析107例HICH患者资料,小骨窗开颅血肿清除术48例为小骨窗组,神经内镜下经外侧裂入路血肿清除术59例为神经内镜组。对比2组患者手术一般情况以及血肿清除率,比较2组患者术前及术后7 d的预后情况、神经功能缺损情况、血清炎症因子水平以及神经功能指标含量变化,观察并记录2组患者术后并发症。结果神经内镜组的手术时间、脑脊液恢复时间以及置管时间较小骨窗组均显著缩短(P<0.05),术中出血量较小骨窗组显著减少(P<0.05),血肿清除率小骨窗组显著提高(P<0.05);术后7 d,神经内镜组和小骨窗组的GOS评分较术前均显著提升(P<0.05),NFDS评分较术前均显著降低(P<0.05),组间对比差异有统计学意义(P<0.05);术后7 d,神经内镜组和小骨窗组的血清IL-6水平均较术前显著升高(P<0.05),但神经内镜组显著低于小骨窗组(P<0.05);2组血清NSE水平、血清S100蛋白含量相比术前均显著降低(P<0.05),神经内镜组显著低于小骨窗组(P<0.05);神经内镜组术后并发症发生率相比小骨窗组显著下降(3.39%比14.58%,P<0.05)。结论神经内镜下经外侧裂入路血肿清除术治疗HICH患者效果明确,相较于小骨窗开颅血肿清除术能明显缩短手术时间、脑脊液恢复时间及置管时间,降低术中出血量,提升血肿清除率,并能改善患者预后,临床应用安全、有效。

Objective To probe the efficacy and safety of small bone window craniotomy hematoma removal and neuroendoscopic hematoma removal via lateral fissure approach in the treatment of patients with hypertensive intracerebral hemorrhage(HICH).Methods The data of 107 patients with HICH were retrospectively analyzed,48 patients with small bone window craniotomy hematoma removal were selected as small bone window group,and 59 patients with neuroendoscopic hematoma removal via lateral fissure approach were enrolled as neuroendoscopic group.The general situation of surgery and hematoma removal rate and prognosis,neurological deficit,serum inflammatory factors and neurological function indicators before surgery and at 7 days after surgery were compared between the two groups,and the postoperative complications were observed and recorded in both groups.Results The surgical time,cerebrospinal fluid recovery time and catheterization time in neuroendoscopic group were significantly shortened compared with those in small bone window group(P<0.05),and the intraoperative blood loss was significantly reduced compared with that in small bone window group(P<0.05),and the hematoma removal rate was significantly raised compared to small bone window group(P<0.05).At 7 days after surgery,the GOS score in neuroendoscopic group and small bone window group was significantly increased compared to that before surgery(P<0.05),and the NFDS score was significantly declined compared to that before surgery(P<0.05),and there were statistical differences between both groups(P<0.05).At 7 days after surgery,serum level of IL-6 in neuroendoscopic group and small bone window group was significantly risen compared with that before surgery(P<0.05),but the level in neuroendoscopic group was significantly lower than that in small bone window group(P<0.05).The levels of serum NSE and serum S100 protein in both groups were significantly decreased compared to those before surgery(P<0.05),and the levels in neuroendoscopic group were significantly lower than those in small bone window group(P<0.05).The total incidence rate of postoperative complications in neuroendoscopic group was significantly lower than that in small bone window group(3.39%vs 14.58%,P<0.05).Conclusion Neuroendoscopic hematoma removal via lateral fissure approach has a clear effect in the treatment of patients with HICH.Compared with small bone window craniotomy hematoma removal,it can significantly shorten the surgical time,cerebrospinal fluid recovery time and catheterization time,reduce the intraoperative blood loss,enhance the hematoma removal rate,and its clinical application is safe and effective.