锥颅血肿外引流与神经内镜手术治疗老年基底节区高血压性脑出血的疗效分析

Efficacy analysis of external drainage of conocephalic hematoma and neuroendoscopic surgery for senile hypertensive intracerebral hemorrhage in basal ganglia

目的探讨颅内压监护下血肿穿刺外引流术和神经内镜结合球囊通道辅助下血肿清除术治疗老年基底节区高血压性脑出血(HICH)患者的临床疗效。方法选取深圳市龙岗中心医院神经外科自2017年8月至2021年2月收治的68例老年基底节区HICH患者,按照随机数字表法分为锥颅组和内镜组,每组34例。锥颅组采用颅内压监护下血肿穿刺外引流术,内镜组采用神经内镜结合球囊通道辅助下血肿清除手术。比较2组患者的手术时间、术后第2天的血肿清除率、甘露醇使用时间、住院时间、住院费用、手术并发症(肺部感染、深静脉血栓)发生率和术后6个月的GOSE评分,分析其临床疗效。结果锥颅组的手术时间[19.5(15.23,22.47)min]、住院时间[(14.53±3.05)d]明显短于内镜组[84.23(75.25,91.80)min、(30.89±9.53)d],术后第2天的血肿清除率(53.67%±13.10%)低于内镜组(87.80%±6.10%),甘露醇使用时间[2.00(0.00,3.75)d]长于内镜组[0.00(0.00,1.00)d],住院费用[(2.39±0.45)万元]少于内镜组[(5.21±1.30)万元],差异均具有统计学意义(P<0.05)。2组患者肺部感染率、深静脉血栓发生率和术后6个月GOSE评分比较,差异均无统计学意义(P>0.05)。2组均无患者死亡。结论对于老年基底节区HICH患者,颅内压监护下血肿穿刺外引流术较神经内镜结合球囊通道辅助下血肿清除手术效率高、住院时间短、预后更优,而且可以减轻患者及其家庭的经济压力。

Objective To explore the clinical efficacy of hematoma puncture and external drainage under intracranial pressure monitoring and neuroendoscopy combined with balloon channel assisted hematoma evacuation in the treatment of elderly patients with hypertensive intracerebral hemorrhage(HICH)in the basal ganglia region.Methods From August 2017 to February 2021,68 elderly patients with basal ganglia HICH admitted to the Neurosurgery Department of Longgang Central Hospital in Shenzhen were randomly divided into a cone group and an endoscopic group,with 34 cases in each group.The cone group underwent hematoma puncture and external drainage under intracranial pressure monitoring,while the endoscopic group underwent hematoma evacuaton with the assistance of neuroendoscopy combined with balloon channel.The surgical time,hematoma clearance rate on the second day after surgery,mannitol use time,length of hospitlization,hospitalization costs,incidence of surgical complications(pulmonary infection,deep vein thrombosis),and GOSE score at 6 months after surgery were compared between two groups of patients,and their clinical efficacy were analyzed.Results The surgical time[19.5(15.23,22.47)min]and the hospitalization time was[(14.53±3.05)d]in the cone group were significantly shorter than those in the endoscopic group[84.23(75.25,91.80)min,(30.89±9.53)d].The hematoma clearance rate on the second day after surgery(53.67%±13.10%)was lower than that in the endoscopic group(87.80%±6.10%),and the use time of mannitol[2.00(0.00,3.75)d]was longer than that in the endoscopic group[0.00(0.00,1.00)d].The hospitalization cost(23900±4500)yuan was less than that in the endoscopic group(52100±13000)yuan,the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of surgical complications such as pulmonary infection,deep vein thrombosis,and GOSE scores at 6 months after surgery between the two groups of patients(P>0.05).Both groups had no patient deaths.Conclusion For elderly patients with HICH in the basal ganglia,hematoma puncture and external drainage under intracranial pressure monitoring is more efficient than neuroendoscopy combined with balloon channel assisted hematoma evacuation,with shorter hospital stay,and better prognosis,and it can also reduce the economic pressure on patients and their families.