Effect of minimally invasive intracranial hematoma drainage on inflammatory factors, serum ferritin and serum P substance in patients with hypertensive cerebral hemorrhage

Objective:To study the effect of minimally invasive intracranial hematoma drainage on inflammatory factors, serum ferritin and serum P substance in patients with hypertensive cerebral hemorrhage.Methods:92 cases of hypertensive cerebral hemorrhage patients in our hospital were selected and randomly divided into 2 groups: minimally invasive group (51 cases) and routine group (41 cases). Minimally invasive intracranial hematoma drainage was performed on the minimally invasive group. Bone flap decompression or small bone window craniotomy were used in the routine group. Tumor necrosis factorα (TNF-α), interleukin-6 (IL-6), high sensitive C reactive protein (hs-CRP) and serum protein (SF), serum substance P (SP) in the 2 groups were detected before treatment and 2 weeks after treatment.Results: The comparison of TNF-α, IL-6, hs-CRP, SP, and SF in the two groups before treatment was not statistically significant (P>0.05). TNF-α, IL-6, hs-CRP and SF in both groups after treatment significantly decreased, compared with that before treatment (P<0.01,P<0.05). TNF-α, IL-6, and SF in minimally invasive group decreased more significantly than that in routine group (P<0.01);The comparison of SP in the two groups after treatment significantly increased compared with that before treatment (P<0.01,P<0.05). SP in minimally invasive group increased more significantly than that in routine group (P<0.05).Conclusions:Compared with bone flap decompression or small bone window craniotomy, minimally invasive intracranial hematoma drainage can inhibit inflammatory reaction, reduce the degree of nerve damage and alleviate clinical symptoms more effectively.

Short-term effect and long-term prognosis of neuroendoscopic minimally invasive surgery for hypertensive int-racerebral hemorrhage

BACKGROUND Hypertensive intracerebral hemorrhage is a common critical disease of the nervous system,comprising one fifth of all acute cerebrovascular diseases and has a high disability and mortality rate.It severely affects the patients’quality of life.AIM To analyze the short-term effect and long-term prognosis of neuroendoscopic minimally invasive surgery for hypertensive intracerebral hemorrhage.METHODS From March 2018 to May 2020,118 patients with hypertensive intracerebral hemorrhage were enrolled in our study and divided into a control group and observation group according to the surgical plan.The control group used a hard-channel minimally invasive puncture and drainage procedure.The observation group underwent minimally invasive neuroendoscopic surgery.The changes in the levels of serum P substances(SP),inflammatory factors[tumor necrosis factor-α,interleukin-6(IL-6),IL-10],and the National Hospital Stroke Scale(NIHSS)and Barthel index scores were recorded.Surgery related indicators and prognosis were compared between the two groups.RESULTS The operation time(105.26±28.35)of the observation group was min longer than that of the control group,and the volume of intraoperative bleeding was 45.36±10.17 mL more than that of the control group.The hematoma clearance rates were 88.58%±4.69%and 94.47%±4.02%higher than those of the control group at 48 h and 72 h,respectively.Good prognosis rate(86.44%)was higher in the observation group than in the control group,and complication rate(5.08%)was not significantly different from that of the control group(P>0.05).The SP level and Barthel index score of the two groups increased(P<0.05)and the inflam-matory factors and NIHSS score decreased(P<0.05).The cytokine levels,NIHSS score,and Barthel index score were better in the observation group than in the control group(P<0.05).CONCLUSION Neuroendoscopic minimally invasive surgery is more complicated than hard channel minimally invasive puncture drainage in the treatment of hypertensive intracerebral hemorrhage;however,hematoma clearance is more thorough,and the short-term effect and long-term prognosis are better than hard channel minimally invasive puncture drainage.

Minimally invasive thalamic hematoma drainage can improve the six-month outcome of thalamic hemorrhage

Objective To explore predictors of the 6-month clinical outcome ofthalamic hemorrhage, and evaluate if minimally invasive thalamic hematoma drainage （THD） could improve its prognosis. Methods A total of 54 patients with spontaneous thalamic hemorrhage were evaluated retrospectively. Clinical data, including demographics, stroke risk factors, neuroimaging variables, Glasgow Coma Score （GCS） on admission, surgical strategy, and outcome, were collected. Clinical outcome was assessed using a modified Rankin Scale, six months after onset. Univariate analysis and multivariate logistic regression analysis were performed to determine predictors of a poor outcome. Results Conservative treatnaent was performed for five patients （9.3%）, external ventricular drainage （EVD） for 20 patients （37.0%）, THD for four patients （7.4%）, and EVD combined with THD for 25 patients （46.3%）. At six months after onset, 21 （38.9%） patients achieved a favorable outcome, while 33 （61.1%） had a poor outcome. In the univariate analysis, predictors of poor 6-month outcome were lower GCS on admis- sion （P = 0.001）, larger hematoma volume （P 〈 0.001）, midline shift （P = 0.035）, acute hydrocephalus （P = 0.039）, and no THD （P = 0.037）. The independent predictors of poor outcome, according to the multivariate logistic regression analysis, were no THD and larger hematoma volume. Conclusions Minimally invasive THD, which removes most of the hematoma within a few days, with limited damage to perihematomal brain tissue, improved the 6-month outcome of thalamic hemorrhage. Thus, THD can be widely applied to treat patients with thalamic hemorrhage.

A minimally invasive multiple percutaneous drainage technique for acute necrotizing pancreatitis

BACKGROUND: In approximately 20% of patients, necrotizing pancreatitis is complicated with severe acute pancreatitis, with high morbidity and mortality rates. Minimally invasive step-up approach is both safe and effective, but sometimes requires multiple access sites.METHODS: A 62-year-old woman was admitted with diabetic ketoacidosis, and initial computed tomography(CT) revealed no evidence of acute pancreatitis. She was clinically improved with insulin therapy, fl uid administration, and electrolyte replacement. However, on the 14 th day of admission, she developed a high-grade fever, and CT demonstrated evidence of acute necrotizing pancreatitis with a large collection of peripancreatic fl uid. Percutaneous transgastric drainage was performed and a 14 French gauge(Fr) pigtail catheter was placed 1 week later, which drained copious pus. Because of persistent high-grade fever and poor clinical improvement, multiple 8 and 10 Fr pigtail catheters were placed via the initial drainage route, allowing the safe and effective drainage of the extensive necrotic tissue that was occupying the bilateral anterior pararenal space.RESULTS: After drainage, the patient recovered well and the last catheter was removed on day 123 of admission.CONCLUSIONS: Multiple percutaneous drainage requires both careful judgment and specialist skills. The perforation of the colon and small bowel as well as the injury of the kidney and major vessels can occur. The current technique appears to be safe and minimally invasive compared with other drainage methods in patients with extended, infected necrotic pancreatic pseudocysts.

Infection recurrence following minimally invasive treatment in patients with infectious pancreatic necrosis

BACKGROUND In recent decades,an increasing number of patients have received minimally invasive intervention for infected pancreatic necrosis(IPN)because of the benefits in reducing postoperative multiple organ failure and mortality.However,there are limited published data regarding infection recurrence after treatment of this patient population.AIM To investigate the incidence and prediction of infection recurrence following successful minimally invasive treatment in IPN patients.METHODS Medical records for 193 IPN patients,who underwent minimally invasive treatment between February 2014 and October 2018,were retrospectively reviewed.Patients,who survived after the treatment,were divided into two groups:one group with infection after drainage catheter removal and another group without infection.The morphological and clinical data were compared between the two groups.Significantly different variables were introduced into the correlation and multivariate logistic analysis to identify independent predictors for infection recurrence.Sensitivity and specificity for diagnostic performance were determined.RESULTS Of the 193 IPN patients,178 were recruited into the study.Of them,9(5.06%)patients died and 169 patients survived but infection recurred in 13 of 178 patients(7.30%)at 7(4-10)d after drainage catheters were removed.White blood cell(WBC)count,serum C-reactive protein(CRP),interleukin-6,and procalcitonin levels measured at the time of catheter removal were significantly higher in patients with infection than in those without(all P<0.05).In addition,drainage duration and length of the catheter measured by computerized tomography scan were significantly longer in patients with infection(P=0.025 and P<0.0001,respectively).Although these parameters all correlated positively with the incidence of infection(all P<0.05),only WBC,CRP,procalcitonin levels,and catheter length were identified as independent predictors for infection recurrence.The sensitivity and specificity for infection prediction were high in WBC count(≥9.95×109/L)and serum procalcitonin level(≥0.05 ng/mL)but moderate in serum CRP level(cut-off point≥7.37 mg/L).The catheter length(cut-off value≥8.05 cm)had a high sensitivity but low specificity to predict the infection recurrence.CONCLUSION WBC count,serum procalcitonin,and CRP levels may be valuable for predicting infection recurrence following minimally invasive intervention in IPN patients.These biomarkers should be considered before removing the drainage catheters.

Quality of life after surgical and endoscopic management of severe acute pancreatitis: A systematic review

BACKGROUND Treatment for severe acute severe pancreatitis(SAP)can significantly affect Health-related quality of life(HR-QoL).The effects of different treatment strategies such as endoscopic and surgical necrosectomy on HR-QoL in patients with SAP remain poorly investigated.AIM To critically appraise the available evidence on HR-QoL following surgical or endoscopic necrosectomy in patient with SAP.METHODS A literature search was performed on PubMed,Google^(TM) Scholar,the Cochrane Library,MEDLINE and Reference Citation Analysis databases for studies that investigated HR-QoL following surgical or endoscopic necrosectomy in patients with SAP.Data collected included patient characteristics,outcomes of interventions and HR-QoL-related details.RESULTS Eleven studies were found to have evaluated HR-QoL following treatment for severe acute pancreatitis including 756 patients.Three studies were randomized trials,four were prospective cohort studies and four were retrospective cohort studies with prospective follow-up.Four studies compared HR-QoL following surgical and endoscopic necrosectomy.Several metrics of HR-QoL were used including Short Form(SF)-36 and EuroQol.One randomized trial and one cohort study demonstrated significantly improved physical scores at three months in patients who underwent endoscopic necrosectomy compared to surgical necrosectomy.One prospective study that examined HR-QoL following surgical necrosectomy reported some deterioration in the functional status of the patients.On the other hand,a cohort study that assessed the long-term HR-QoL following sequential surgical necrosectomy stated that all patients had SF-36>60%.In the only study that examined patients following endoscopic necrosectomy,the HR-QoL was also very good.Three studies investigated the quality adjusted life years suggesting that endoscopic and surgical approaches to management of pancreatic necrosis were comparable in cost effectiveness.Finally,regarding HR-QoL between open necrosectomy and minimally invasive approaches,patients who underwent the later had a significantly better overall quality of life,vitality and mental health.CONCLUSION This review would suggest that the endoscopic approach might offer better HR-QoL compared to surgical necrosectomy.However,the available comparative literature was very limited.More randomized trials powered to detect differences in HR-QoL are required.

Minimally invasive outpatient management of iliopsoas muscle abscess in complicated spondylodiscitis

BACKGROUND Iliopsoas muscle abscess(IPA)and spondylodiscitis are two clinical conditions often related to atypical presentation and challenging management.They are both frequently related to underlying conditions,such as immunosuppression,and in many cases they are combined.IPA can be primary due to the hematogenous spread of a microorganism to the muscle or secondary from a direct expansion of an inflammatory process,including spondylodiscitis.Computed tomographyguided percutaneous drainage has been established in the current management of this condition.AIM To present a retrospective analysis of a series of 8 immunocompromised patients suffering from spondylodiscitis complicated with IPA and treated with percutaneous computed tomography-guided drainage and drain insertion in an outpatient setting.METHODS Patient demographics,clinical presentation,underlying conditions,isolated microorganisms,antibiotic regimes used,abscess size,days until the withdrawal of the catheter,and final treatment outcomes were recorded and analyzed.RESULTS All patients presented with night back pain and local stiffness with no fever.The laboratory tests revealed elevated inflammatory markers.Radiological findings of spondylodiscitis with unilateral or bilateral IPA were present in all cases.Staphylococcus aureus was isolated in 3 patients and Mycobacterium tuberculosis in 2 patients.Negative cultures were found in the remaining 3 patients.The treatment protocol included percutaneous computed tomographyguided abscess drainage and drain insertion along with a course of targeted or empiric antibiotic therapy.All procedures were done in an outpatient setting with no need for patient hospitalization.CONCLUSION The minimally invasive outpatient management of IPA is a safe and effective approach with a high success rate and low morbidity.

Invasive intervention timing for infected necrotizing pancreatitis: Late invasive intervention is not late for collection

With the advance of invasive interventions,the treatment model for infected necrotizing pancreatitis(INP)has shifted from open surgery to the step-up minimally invasive treatment.Late intervention,originating from the open surgery era,has been questioned in the minimally invasive period.With the emergence of new high-quality evidence about the timing for intervention,it seems to be increasingly apparent that,even in the age of minimal invasiveness,“late intervention”waiting for the necrotic collections to be encapsulated is still necessary.This opinion review mainly discusses the intervention timing for INP.

注射体积对老年患者中等量基底节区脑出血微创穿刺术后临床疗效的影响

目的探讨药物总量控制下注射体积对老年患者中等量基底节区脑出血微创穿刺术后临床疗效的影响。方法以血肿最大层面长轴中心点为穿刺点,CT引导穿刺,穿刺成功后抽吸液态血肿,控制血肿腔内单次尿激酶总量4.0×10^(4)U,注射体积分别为2 mL和4 mL,根据术后CT结果调整针体深度,并根据血肿清除情况拔针。比较两组术后血肿清除率、颅内压、血肿周围水肿体积、总死亡率、并发症发生率、神经功能缺失评分(neurological deficit score,NDS)和日常生活能力评定(activities of daily living,ADL)结果。结果两组患者术后首次血肿清除率(31.17%±1.46%vs.30.50%±1.69%)、术后颅内压、总死亡率无明显差异(P均>0.05)。大体积组术后1 d(77.30%±3.75%vs.62.77%±3.89%),2 d(91.43%±4.05%vs.80.12%±4.15%),拔针前(92.35%±4.83%vs.85.9%±3.59%)血肿清除率明显高于小体积组(P<0.05)。大体积组留针时间(1.8 d±0.2 d vs.3.1 d±0.4 d,P<0.05)、尿激酶总用量(24.3×10^(4)U±2.3×10^(4)U vs.36.5×10^(4)U±4.7×10^(4)U,P<0.05)均少于小体积组(P<0.05)。大体积组术后3 d(11.33 mL±2.32 mL vs.16.45 mL±1.97 mL)、5 d(14.59 mL±2.11 mL vs.21.37 mL±2.43 mL)、7 d(22.79 mL±3.15 mL vs.30.15 mL±4.04 mL)、14 d(12.41 mL±1.95 mL vs.19.38 mL±2.47 mL)血肿周围水肿体积少于小体积组(P<0.05)。大体积组术后28 d、3个月、6个月NDS[分别为(22.35±2.49 vs.28.14±2.95)、(16.43±2.17 vs.23.81±2.56)、(11.39±1.87 vs.17.74±2.03)]及ADL评分[分别为(44.76±4.22 vs.36.15±2.36)、(62.55±3.81 vs.51.39±2.45)、(77.53±3.76 vs.60.81±4.35)]优于小体积组(P<0.05)。大体积组术后并发症发生率低于小体积组(P<0.05)。结论大体积注射法能更有效引流血肿,缩短留针时间,减少尿激酶用量,降低术后并发症发生率,改善患者预后,是老年中等量基底节区脑出血微创穿刺术后提高疗效的有效方法。

不同微创穿刺引流时间窗对高血压基底节脑出血患者预后的影响

目的比较不同微创穿刺引流时间窗下高血压基底节脑出血患者的临床疗效及对预后的影响。方法回顾性收集保定市第一中心医院神经外科行微创穿刺引流术的150例高血压基底节脑出血患者的相关资料,采集时间2020-01—2023-01,按不同时间窗将患者分为超早期组(于发病6 h内实施手术)、早期组(于发病6~24 h内实施手术)与延期组(于发病24 h后实施手术)各50例。比较3组患者手术情况,采用美国国立卫生研究院卒中量表(NIHSS)及日常生活活动量表(ADL)评估治疗前后神经功能及生活质量的变化,并统计各组疗效及预后情况。结果早期组术后3 d血肿残余量明显(7.84±1.94)mL少于超早期组(10.23±2.56)mL与延期组(12.30±2.22)mL,且住院时间(15.02±6.13)d也明显短于超早期组(18.38±5.41)d与延期组(20.57±5.88)d(P<0.05);治疗后各组NIHSS评分均降低,ADL评分均升高(P<0.05),早期组各评分改善情况最显著(P<0.05);超早期组、早期组、延期组临床有效率分别为74.00%、94.00%、70.00%,早期组明显高于超早期组与延期组(P<0.05),但超早期组与延期组比较,差异无统计学意义(P>0.05);3组格拉斯哥预后量表(GOS)分级情况显示,早期组优于超早期组与延期组,差异有统计学意义(P<0.05)。结论微创穿刺引流治疗高血压基底节脑出血疗效显著,但以发病6~24 h进行手术的效果更为理想,其不仅能加快术后恢复,缩短住院时间,还可在提高患者神经功能及生活质量的同时改善术后预后情况。

两种手术方式治疗高血压脑出血患者的临床效果及复发因素探讨

目的 探讨微创穿刺血肿引流术(MIPHD)与开颅血肿清除术治疗高血压脑出血(HICH)的效果以及复发的危险因素。方法 80例HICH患者根据治疗方案的不同分为MIPHD组和开颅手术组,比较两组的治疗效果和临床指标,分析影响HICH患者复发的危险因素。结果 治疗后,两组的NIHSS评分均显著低于治疗前(P <0.05)。Logistic回归分析显示,入院SBP、出血量、凝血机制异常是影响HICH患者术后复发的危险因素(P <0.05)。结论 微创穿刺血肿引流术和开颅血肿清除术均可改善HICH患者的神经缺损程度,对于术前SBP过高、出血量偏大、凝血机制异常的患者,应警惕术后HICH的复发。

中西医结合治疗非哺乳期乳腺炎脓肿期肝胃郁热证的临床疗效观察

目的:观察超声引导下微创置管引流术联合疏肝散结汤治疗非哺乳期乳腺炎脓肿期肝胃郁热证的临床疗效。方法:选取2021年1月-2023年5月南通市中医院乳腺外科收治的非哺乳期乳腺炎脓肿期肝胃郁热证患者63例,按随机数字表法分为A组、B组与C组,A组23例,B组与C组各20例。A组、C组行超声引导下微创置管引流术,B组行脓肿切开引流术,A组行超声引导下微创置管引流术后1周予疏肝散结汤口服4周。观察患者临床症状体征(术后疼痛评分、疤痕长度、乳房外形评分)、疗效指标(手术时间、拔管时间、复发率)、实验室指标[白细胞计数(WBC)、C反应蛋白(CRP)、血沉(ESR)、肝素结合蛋白(HBP)]。结果:3组治疗前实验室指标WBC、CRP、ESR、HBP差异无统计学意义(P <0.05),治疗后3组各项指标均较治疗前显著降低(P <0.05),且A组各指标低于B组、C组(P <0.05);手术时间、复发率3组差异无统计学意义(P <0.05),术后疼痛评分、疤痕长度、乳房外形评分、拔管时间A组、C组均低于B组(P <0.05),A组与C组无明显差异(P <0.05)。3组不良反应发生率差异无统计学意义(P <0.05)。结论:超声引导下微创置管引流术联合疏肝散结汤治疗非哺乳期乳腺炎脓肿期肝胃郁热证,能够有效控制局部炎症,具有创伤小、切口美观、术后恢复快的特点,临床疗效显著,安全有效。

CT定位辅助下微创穿刺引流术对高血压脑出血患者神经功能缺损评分与并发症发生情况的影响

目的探讨CT定位辅助下微创穿刺引流术对高血压脑出血(HICH)患者神经功能缺损评分与并发症发生情况的影响。方法选取2019年1月至2022年3月昌邑市人民医院收治的96例HICH患者作为研究对象,按照奇偶数法分为A组与B组,每组48例。A组行CT定位辅助下微创穿刺引流术治疗,B组行小骨窗开颅血肿清除术治疗,比较两组基本手术指标、神经功能损伤程度[神经功能缺损评分(NFDS)]及日常生活能力[Barthel指数评定量表(BI)]、生命质量[脑卒中影响量表(SIS)]、血管内皮功能[一氧化氮(NO)、内皮素-1(ET-1)]、并发症发生情况、不良事件发生情况。结果A组术中出血量少于B组,住院时间短于B组,血肿清除率高于B组,差异有统计学意义(P<0.05)。治疗后,两组NFDS评分均低于治疗前,BI评分均高于治疗前,且A组NFDS评分低于B组,BI评分高于B组,差异有统计学意义(P<0.05)。治疗后,两组交流、日常生活能力、移动能力、情感、参与、力气、手功能、记忆与思维评分均高于治疗前,且A组高于B组,差异有统计学意义(P<0.05)。治疗后,两组NO水平均高于治疗前,ET-1水平均低于治疗前,且A组NO水平高于B组,ET-1水平低于B组,差异有统计学意义(P<0.05)。A组并发症发生率低于B组,差异有统计学意义(P<0.05)。两组不良事件发生率比较差异无统计学意义。结论CT定位辅助下微创穿刺引流术疗效更佳,可有效减轻患者神经功能损伤,减少并发症发生,值得临床推广应用。

CT定位下硬通道微创穿刺引流术联合尿激酶灌注治疗老年高血压脑出血患者的效果

目的:分析CT定位下硬通道微创穿刺引流术联合尿激酶灌注治疗老年高血压脑出血患者的效果。方法:选取2018年3月—2023年3月如东县人民医院收治的102例老年高血压脑出血患者。根据入院顺序进行编号,利用最新统计学软件生成随机序列后将其分为对照组(51例)和观察组(51例)。对照组给予保守治疗,观察组在对照组基础上给予CT定位下硬通道微创穿刺引流术联合尿激酶灌注治疗。比较两组治疗1周后临床疗效,治疗前及治疗1周后血管内皮功能、预后及生活质量,并发症。结果:观察组治疗总有效率高于对照组,差异有统计学意义(P<0.05)。治疗1周后,观察组一氧化氮(nitric oxide,NO)水平高于对照组,内皮素-1(endothelin-1,ET-1)水平低于对照组,差异有统计学意义(P<0.05)。治疗1周后,观察组改良Rankin量表(modified Rankin scale,mRS)评分低于对照组,改良Barthel指数(modified Barthel index,MBI)评分高于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论:对于老年高血压脑出血患者采取CT定位下硬通道微创穿刺引流术联合尿激酶灌注治疗效果显著,有利于改善血管内皮功能,提高预后及生活质量水平,并降低并发症发生率。

不同引流术治疗Morel-Lavallée损伤的对比研究

目的探讨应用改良封闭式负压引流技术与传统负压引流治疗Morel-Lavallée损伤的疗效。方法选取本院2020年1月至2023年6月收治的36例Morel-Lavallée损伤患者。根据手术方式随机分为对照组与试验组各18例。结果术前两组间的性别、年龄构成差异无统计学意义(P>0.05)。经改良封闭式负压吸引治疗Morel-Lavallée损伤在再手术次数、切口愈合时间以及住院时间上均少于传统负压引流,差异有统计学意义(P<0.05)。而两组术后B超检查,残留空隙,积液对比差异无统计学意义(P>0.05)。结论改良封闭式负压引流技术治疗Morel-Lavallée损伤安全、有效,缩短住院及1期愈合时间,值得临床进一步推广。

微孔穿刺引流联合尿激酶治疗对脑出血后脑水肿程度及血清丙二醛、基质金属蛋白酶-9和细胞黏附分子-1水平的影响

目的观察微孔穿刺引流术(对照组)联合尿激酶(UK)治疗对脑出血后脑水肿程度及血清丙二醛(MDA)、基质金属蛋白酶-9(MMP-9)和细胞黏附分子-1(ICAM-1)水平的影响。方法2020年1月~2022年9月在我院收治的高血压性脑出血(HICH)病人82例,根据不同治疗方案分为两组,观察组44例,采用对照组联合UK治疗,对照组38例,采用对照组治疗。观察两组病人脑水肿体积、神经功能[美国国立卫生研究院卒中量表(NIHSS)]、血清学指标MDA、MMP-9和ICAM-1。记录术后并发症发生情况,对比两组术后3个月的预后情况[格拉斯哥结局量表评分(GOS)、日常生活能力(ADL)评分和死亡情况]。结果术后14天,观察组的周围脑水肿体积为(14.76±2.39)ml,低于对照组的(16.87±2.24)ml,差异有统计学意义(P<0.05);观察组NIHSS评分为(11.12±1.96)分,低于对照组的(11.96±1.65)分。两组比较,差异有统计学意义(P<0.05);观察组的血清MDA、MMP-9、ICAM-1水平分别为(8.65±1.16)nmol/ml、(96.17±19.34)ng/ml和(624.31±32.76)μg/ml,均低于对照组的(16.14±2.16)nmol/ml、(120.47±21.32)ng/ml和(661.24±35.21)μg/ml。两组比较差异有统计学意义(P<0.05)。观察组术后并发症发生率为9.09%,与对照组的18.42%比较,差异无统计学意义(P>0.05)。两组术后3个月内均无死亡病例。观察组术后3个月的GOS评分和ADL评分分别为(4.03±0.92)分、(71.21±12.65)分,均高于对照组的(3.52±1.12)分、(62.98±15.58)分,两组比较差异有统计学意义(P<0.05)。结论HICH病人应用对照组联合UK治疗可有效控制脑水肿,下调MDA、MMP-9、ICAM-1水平,保护神经功能,改善预后。

CT三维重建引导下微创软通道穿刺引流术对脑出血治疗效果

目的不同微创软通道穿刺引流术对脑出血患者治疗效果。方法回顾性选取2022年10月至2023年10月南阳市中心医院收治的117例脑出血患者,根据不同的治疗方式分为接受传统微创软通道穿刺引流术治疗的对照组(56例),以及接受CT三维重建引导下微创软通道穿刺引流术治疗的试验组(61例)。比较2组患者手术相关指标(手术时间、插管一次性成功率、12 h脑内血肿清除率、术后住院时间),血清脑原性神经营养因子(BDNF)、水通道蛋白4(AQP4)水平,神经功能缺损程度及术后并发症发生情况。结果2组脑内血肿清除率差异无统计学意义(P>0.05),但试验组插管一次性成功率显著高于对照组,手术时间、术后住院时间显著短于对照组(P<0.05);术后14 d,试验组血清BDNF水平显著高于对照组,血清AQP4水平显著低于对照组(P<0.05);术后6个月,试验组美国国立卫生研究院卒中量表(NIHSS)评分显著低于对照组(P<0.05);术后试验组并发症总发生率显著低于对照组(P<0.05)。结论CT三维重建引导下微创软通道穿刺引流术治疗脑出血效果血肿清除率与常规微创穿刺引流术相当,且其能有效缩短手术时间、住院时间,提高插管成功率,对神经功能损伤小,能有效调节血清BDNF、AQP4水平,术后并发症少,安全可靠。

关注内引流与外引流微创青光眼手术的合理选用

青光眼是不可逆性致盲眼病的首要原因,原发性开角型青光眼是其中的主要类型,其致病机制复杂,但降眼压仍是目前公认的最有效治疗手段。主流的抗青光眼手术是通过增加房水引流达到降低眼压的效果。近二十年来,微创/微小切口抗青光眼手术(MIGS)逐渐成为青光眼手术的热点,国内也逐步开展相关术式,但临床效果并非完全理想。建议眼科医师应在充分理解房水流出路径的解剖、病理生理学特点和各种MIGS手术方式设计原理的基础上,了解各术式的优势和局限性,合理选择内引流和外引流MIGS,规范化开展微创青光眼手术。期待未来能利用无创的多模式影像学手段协助术前评估术眼的结构和功能,为患者个体化选择和规划治疗方式,实现青光眼的精准治疗。

TRAIL及CD64表达与脑出血微创血肿穿刺引流术后颅内感染的相关性

目的探讨脑出血微创血肿穿刺引流术后患者血清和脑脊液中的肿瘤坏死因子相关的诱导凋亡的配体(TRAIL)及IgGFc受体Ⅰ(CD64)表达水平与术后颅内感染的相关性。方法回顾性分析2019年1月至2020年12月在信阳市人民医院神经外科接受脑出血微创血肿穿刺引流术治疗的70例患者的临床资料,根据术后是否发生颅内感染分为感染组(n=25)和非感染组(n=45)。比较两组患者的一般资料、临床特征、手术方式、手术时间、住院时间等。采用酶联免疫吸附法(ELISA)检测并比较两组患者术前、术后24h、48h、72h的血清和脑脊液中TRAIL及CD64的表达水平。采用Spearman相关系数法分析TRAIL及CD64的表达水平与各观察指标间的相关性。结果两组患者的一般资料比较差异均无统计学意义(P>0.05);感染组患者的手术时间和住院时间分别为(62.4±15.3)min、(18.6±4.7)d,明显长于非感染组的(54.8±12.6)min、(15.3±3.8)d,差异均有统计学意义(P<0.05);两组患者术后24 h、48 h、72 h血清和脑脊液中的TRAIL和CD64表达水平随着时间的延长呈上升趋势,且观察组明显高于非感染组,差异均有统计学意义(P<0.05);Spearman相关系数法分析结果显示,RAIL及CD64的表达水平与NIHSS评分、手术时间、引流管留置时间、住院时间、Hunt-Hess评分均呈正相关(r>0.4,P<0.05)。结论脑出血微创血肿穿刺引流术后患者血清和脑脊液中TRAIL及CD64的表达水平与NIHSS评分、手术时间、引流管留置时间、住院时间、Hunt-Hess评分密切相关,TRAIL及CD64可能作为颅内感染的早期预警和监测指标,为颅内感染的防治提供依据。

脑室外引流术与神经内镜微创手术治疗严重高血压脑室内出血的疗效比较——一项单中心回顾性研究

目的分析神经内镜微创手术与传统脑室穿刺引流术治疗严重高血压脑室内出血的安全性及疗效。方法回顾性分析2020年7月至2023年7月采用神经内镜微创术式清除血肿50例(内镜组)与传统脑室外引流术治疗44例(引流组)的临床资料,观察两组血肿清除率,日常生活能力量表(ADL)分级情况,术后脑积水、继发出血、颅内感染、肺部感染发生率。结果术后内镜组患者血肿清除率大于60%患者比例和ADL分级为Ⅰ、Ⅱ、Ⅲ级者占比均明显高于引流组〔血肿清除率大于60%患者比例:88.0%(44/50)比47.7%(21/44),χ^(2)=17.794,P<0.001;ADL分级为Ⅰ、Ⅱ、Ⅲ级者占比:94.0%(47/50)比77.3%(33/44),χ^(2)=5.459,P=0.019〕,并发症发生率明显低于引流组〔8.0%(4/50)比34.1%(15/44),χ^(2)=9.879,P=0.002〕。结论与脑室外引流术相比,神经内镜微创手术治疗严重高血压脑室内出血可获得更好的治疗结果,达到较高血肿清除率,同时较少发生术后并发症。