B超引导下神经内镜治疗高血压脑出血的手术技巧探讨

Surgical techniques of B-ultrasound guided neuroendoscopic treatment for hypertensive intracerebral hemorrhage

目的探讨术中B超引导下神经内镜治疗高血压脑出血(hypertensive intracerebral hemorrhage,HICH)的手术方法和技巧。方法回顾性分析我院神经外科于2015年1月至2019年12月收治的50例高血压脑出血患者的临床资料。根据手术方法的不同分为两组,神经内镜组25例,行B超引导下神经内镜微创手术;显微镜组25例,行开颅显微镜下血肿清除术。比较两组手术时间、血肿清除率、术中出血量、重症加强护理病房(intensive care unit,ICU)住院天数、3个月后日常生活活动能力(activity of daily living,ADL)评分。结果与显微镜组比较,神经内镜组手术时间、血肿清除率、术中出血量、ICU住院天数均优于显微镜组(P<0.05),术后3个月恢复良好率神经内镜组为84%,显微镜组为64%,两组比较无统计学差异(P>0.05)。结论B超引导下神经内镜治疗HICH创伤较轻,疗效确切,具有较高的临床推广应用价值。

Objective To explore the surgical methods and techniques of intraoperative B-ultrasound guided neuroendoscopic treatment for hypertensive intracerebral hemorrhage(HICH).Methods A retrospective study was conducted on the clinical data of 50 patients with HICH admitted to the neurosurgery department of our hospital from January 2015 to December 2019,in whom 25 patients underwent minimally invasive neuroendoscopic surgery under B-ultrasound guidance(the endoscopic group),and the other 25 cases underwent hematoma removal surgery under craniotomy microscope(the microscopic group).It was compared of the surgical time,hematoma clearance rate,intraoperative bleeding volume,ICU hospitalization days,and 3-month postoperative activity of daily living(ADL)scores between the two groups.Results Compared with the microscopic group,the endoscopic group had better surgical time,hematoma clearance rate,intraoperative bleeding volume,and ICU hospitalization days(P<0.05).The 3-month postoperative excellent and good prognosis rate of the endoscopic group was 84%,which had no significant difference compared with the 64% of the microscopic group(P>0.05).Conclusion Compared with microscopy,the intraoperative B-ultrasound guided neuroendoscopy for the treatment of HICH has shorter surgical time,less intraoperative bleeding,higher hematoma clearance rate,and significant therapeutic effect,which demonstrates high promotion and application value in clinical use.