神经内镜微创手术与小骨窗开颅显微手术治疗幕上高血压脑出血效果比较  

Clinical effect comparison of neuroendoscopic minimally invasive surgery and window craniotomy microsurgery in treating hypertensive basal ganglia intracerebral hemorrhage

作　　者：陈果[1] 董伟[1] 

机构地区：[1]重庆市第五人民医院神经外科,重庆400062

出　　处：《中国医药导报》2015年第7期51-54,共4页China Medical Herald

摘　　要：目的比较神经内镜微创手术与小骨窗开颅显微手术治疗幕上高血压脑出血的临床效果。方法选择2010年1月~2014年1月重庆市第五人民医院收治的86例幕上高血压脑出血患者,根据治疗方法的不同分为神经内镜微创手术组（内镜组,49例）和小骨窗开颅显微手术组（小骨窗开颅组,37例）,比较两组患者的手术时间、出血量、血肿量以及术后并发症及感染等相关情况。结果内镜组手术时间较小骨窗开颅组短[（1.6±1.0）h比（3.6±1.2）h,t=8.625,P〈0.01];术中出血量显著低于小骨窗开颅组[（41.5±20.3）m L比（350.9±110.4）m L,t=20.385,P〈0.01];而血肿清除率则明显高于小骨窗开颅组[（90.1±9.3）%比（75.9±15.8）%,t=5.312,P〈0.01]。不同术前格拉斯哥昏迷（GCS）评分患者术后入住ICU时间内镜组均显著低于小骨窗开颅组（P〈0.01）;内镜组术后平均ICU住院时间也显著低于小骨窗开颅组[（7.0±1.9）d比（13.0±3.6）d,t=10.158,P〈0.01]。内镜组术后感染率显著低于小骨窗开颅组（P〈0.01）。内镜组患者预后整体疗效优于小骨窗开颅组（Z=1.183,P=0.044）。结论神经内镜微创手术较小骨窗显微手术更具微创优势,其手术时间较短、术中出血量较少、术后入住ICU时间较短、血肿清除率较高,且预后效果较好。Objective To compare the clinical effect of endoscopic surgery and window craniotomy in treating hypertensive cerebral hemorrhage. Methods From January 2010 to January 2014, in the Fifth People＇s Hospital of Chongqing City, 86 patients with hypertensive basal ganglia intracerebral hemorrhage were divided into neuroendoscopic minimally invasive surgery group（endoscopic surgery group, 49 cases） and window craniotomy microsurgery（window craniotomy group, 37 cases）, according to the treatment method. The operation time, bleeding volume, hematoma volume, postoperative complication, infection and other relevant circumstances of two groups were compared. Results the operation time in endoscopic group was shorter than that in window craniotomy group [（1.6±1.0） h vs（3.6±1.2） h, t = 8.625, P〈0.01];the bleeding volume in endoscopic group was significantly lower than that in window craniotomy group [（41.5±20.3） m L vs（350.9±110.4） m L, t = 20.385, P〈0.01]; and the hematoma clearance rate in endoscopic group was much higher than that in window craniotomy group [（90.1±9.3）% vs（75.9±15.8）%, t = 5.312, P〈0.01]. The postoperative ICU stay time of patients with different preoperative GCS scores in endoscopic group were significantly lower than those in window craniotomy group（P〈0.01）; the postoperative average ICU time of hospitalization in endoscopic group was significantly lower than that in window craniotomy group [（7.0±1.9） d vs（13.0±3.6） d, t = 10.158, P〈0.01]. The postoperative infection rate in endoscopic group was lower than that in window craniotomy group（P〈0.01）. The total effect of patients in endoscopic group was significantly higher than those in window craniotomy group（Z = 1.183, P = 0.044）.Conclusion The endoscopic surgery has more advantages than window craniotomy, it has shorter operation time, less bleeding, shorter ICU time after surgery, higher rate of hematoma clearance and berrer prognosis.

关 键 词：高血压脑出血 神经内镜 小骨窗开颅 疗效 

分 类 号：R651.1[医药卫生—外科学]