B超辅助神经内镜手术治疗丘脑出血破入脑室的效果观察

Effect of ultrasound-assisted neuroendoscopic surgery on thalamic intraventricular hemorrhage

目的 比较B超辅助神经内镜手术与传统脑室外引流术治疗丘脑出血破入脑室的效果及安全性。方法 2021年1月—2023年12月新乡医学院第一附属医院诊治丘脑出血破入脑室患者47例,其中采用B超辅助神经内镜手术治疗者21例为内镜组,采用脑室外引流术治疗者26例为常规手术组,比较2组术前格拉斯哥昏迷评分(GCS)、术前出血量、术后血肿清除率,术后再出血、颅内感染、脑积水发生率,脑室外引流管留置时间、住院时间,出院格拉斯哥预后评分(GOS)、术后3个月GOS评分、术后3个月GOS评分升高值。结果 内镜组术后1 d血肿清除率[(84.9±2.4)%]、术后7 d血肿清除率[(96.5±1.4)%]、出院GOS评分[(3.1±0.1)分]、术后3个月GOS评分[(3.7±0.1)分]、术后3个月GOS评分升高值[(0.6±0.1)分]均高于常规手术组[(34.3±5.6)%、(73.9±4.4)%、(2.4±0.1)分、(2.6±0.1)分、(0.2±0.1)分](t=7.709、4.434、4.261、6.197、2.861,P均<0.05),术后颅内感染发生率(0)、术后脑积水发生率(14.3%)均低于常规手术组(19.2%、42.3%)(χ^(2)=4.519,P=0.034;χ^(2)=4.362,P=0.037),脑室外引流管留置时间[(6.6±3.3)d]、住院时间[(20.1±7.5)d]均短于常规手术组[(10.0±2.0)、(27.9±11.3)d](t=4.487,P<0.001;t=2.701,P=0.010),术前出血量[(41.3±8.4)mL]、术前GCS评分[(7.4±2.7)分]、术后再出血发生率(9.5%)与常规手术组[(41.1±7.7)mL、(7.5±2.5)分、3.8%]比较差异均无统计学意义(t=0.072,P=0.943;t=0.156,P=0.877;χ^(2)=0.627,P=0.429)。结论 B超辅助神经内镜手术与传统脑室外引流术治疗丘脑出血破入脑室均安全、有效;与传统脑室外引流术相比,B超辅助神经内镜手术血肿清除快、神经功能恢复良好,术后并发症少。

Objective To compare the efficacy and safety of ultrasound-assisted neuroendoscopic surgery and conventional external ventricular drainage surgery in the treatment of thalamic intraventricular hemorrhage.Methods From January 2021 to December 2023,47 patients with thalamic intraventricular hemorrhage were diagnosed and treated in the First Affiliated Hospital of Xinxiang Medical University,among whom 21 patients were performed ultrasound-assisted neuroendoscopic surgery(neuroendoscopic group) and the other 26 patients were performed external ventricular drainage(conventional surgery group).The presurgical Glasgow Coma Scale(GCS),presurgical bleeding volume,postsurgical hematoma clearance rate,incidence rates of postsurgical rebleeding,intracranial infection and hydrocephalus,external ventricular drainage tube indwelling time,length of hospital stay,Glasgow Outcome Scale(GOS) at discharge,and 3 months postsurgical GOS and its improvement were compared between two groups.Results The hematoma clearance rates by day 1 and 7 after surgery,GOS at discharge,and 3 months postsurgical GOS and its improvement were higher in neuroendoscopic group [(84.9%±2.4)%,(96.5±1.4)%,3.1±0.1,3.7±0.1,0.6±0.1] than those in conventional surgery group [(34.3±5.6) %,(73.9±4.4) %,2.4±0.1,2.6±0.1,0.2±0.1](t=7.709,4.434,4.261,6.197,2.861;all P values <0.05),The incidence of intracranial infection and hydrocephalus after surgery were lower in neuroendoscopic group(0,14.3%) than those in conventional surgery group(19.2%,42.3%)(χ^(2)=4.519,P=0.034;χ^(2)=4,362,P=0.037).The external ventricular drainage tube indwelling time and length of hospital stay were shorter in neuroendoscopic group [(6.6±3.3),(20.1±7.5) d] than those in conventional surgery group [(10.0±2.0),(27.9±11.3) d](t=4.487,P<0.001;t=2.701,P=0.010).No significant differences were found in presurgical bleeding volume,presurgical GCS and postsurgical rebleeding rate between neuroendoscopic group [(41.3±8.4) mL,7.4±2.7,9.5%] and conventional surgery group [(41.1±7.7) mL,7.5±2.5,3.8%](t=0.072,P=0.943;t=0.156,P=0.877;χ^(2)=0.627,P=0.429).Conclusion Compared with conventional external ventricular drainage,ultrasound-assisted neuroendoscopic surgery can clear hematoma more quickly,get better neurological recovery,and has fewer postsurgical complications in the treatment of thalamic intraventricular hemorrhage,and both of them two are safe and effective.