神经内镜下经眶上锁孔与显微镜下经侧裂岛叶入路治疗高血压性基底节区脑出血的疗效比较

Efficiency comparison of neuroendoscopic trans-supraorbital keyhole approach and microscopic trans-lateral lobe approach in the treatment of hypertensive basal ganglia hemorrhage

目的比较神经内镜下经眶上锁孔入路与显微镜下经侧裂岛叶入路治疗高血压性基底节区脑出血的临床效果。方法选取52例进行手术治疗的高血压性基底节区脑出血患者进行回顾性分析,根据手术方式不同分为内镜组(28例,采用神经内镜下经眶上锁孔入路治疗)和显微镜组(24例,采用显微镜下经侧裂岛叶入路治疗)。比较两组患者手术时间、术中出血量、血肿清除率、住院时间、术后7 d格拉斯哥昏迷评分法(GCS)评分、神经功能缺损程度、术后并发症发生情况、颅内再出血情况及预后情况。结果内镜组手术时间(82.35±15.26)min、住院时间(11.58±2.09)d短于显微镜组的(162.47±20.43)min、(14.67±2.11)d,术中出血量(109.58±20.45)ml少于显微镜组的(161.67±38.78)ml,血肿清除率(88.24±8.68)%、术后7 d GCS评分(12.88±1.56)分高于显微镜组的(83.07±7.81)%、(11.16±1.24)分,差异有统计学意义(P<0.05)。两组术前美国国立卫生研究院卒中量表(NIHSS)评分比较差异无统计学意义(P>0.05);内镜组术后1周NIHSS评分(7.86±1.56)分低于显微镜组的(11.12±1.83)分,差异有统计学意义(P<0.05)。两组颅内感染、脑脊液漏、继发性脑梗发生率及颅内再出血发生率比较,差异均无统计学意义(P>0.05)。两组格拉斯哥预后评分法(GOS)评分比较,差异无统计学意义(P>0.05)。结论神经内镜下经眶上锁孔入路可以有效治疗高血压性基底节区脑出血,能明显减少术中出血量,提高血肿清除率、术后GCS评分,缩短手术时间和住院时间,且安全性和预后与显微镜下经侧裂岛叶入路手术无明显差异。

Objective To compare the clinical effect of neuroendoscopic trans-supraorbital keyhole approach and microscopic trans-lateral lobe approach in the treatment of hypertensive basal ganglia hemorrhage.Methods A retrospective analysis was performed on 52 patients with hypertensive basal ganglia hemorrhage who underwent surgical treatment.According to different surgical methods,they were divided into endoscope group(28 cases,neuroendoscopic trans-supraorbital keyhole approach)and microscope group(24 cases,microscopic trans-lateral lobe approach).Both groups of patients were compared in terms of operation time,amount of blood loss,hematoma evacuation rate,length of hospital stay,Glasgow coma scale(GCS)score at 7 d postoperatively,degree of neurological deficit,postoperative complications,intracranial bleeding and prognosis.Results The endoscope group had operation time of(82.35±15.26)min and length of hospital stay of(11.58±2.09)d,which were shorter than(162.47±20.43)min and(14.67±2.11)d in the microscope group;the amount of blood loss of(109.58±20.45)ml in the endoscope group was less than(161.67±38.78)ml in the microscope group;the endoscope group had hematoma evacuation rate of(88.24±8.68)%and GCS score at 7 d postoperatively of(12.88±1.56)points,which were higher than(83.07±7.81)%and(11.16±1.24)points in the microscope group;the difference was statistically significant(P<0.05).There was no significant difference in preoperative National Institutes of Health Stroke Scale(NIHSS)score between the two groups(P>0.05).The NIHSS score of(7.86±1.56)points at 1 week postoperatively in the endoscope group was lower than(11.12±1.83)points in the microscope group,and the difference was statistically significant(P<0.05).There were no significant differences in the incidence of intracranial infection,cerebrospinal fluid leakage,secondary cerebral infarction and intracranial rebleeding between the two groups(P>0.05).There was no significant difference in Glasgow outcome scale(GOS)score between the two groups(P>0.05).Conclusion Neuroendoscopic trans-supraorbital keyhole approach can effectively treat basal ganglia hemorrhage,which can significantly reduce the amount of blood loss,improve hematoma evacuation rate and postoperative GCS score,shorten the operation time and length of hospital stay,and the safety and prognosis are not significantly different from those in microscopic trans-lateral lobe approach.