神经内镜与开颅治疗高血压脑出血疗效比较  

Surgical Management of Hypertensive Intracerebral Hemorrhage:a Comparison between Neuro-endoscopic and Craniotomic Hematoma Evacuation

作　　者：雷波[1] 张召[1] 郑念东[1] 万晓强[1] 卫正洪[1] 文伟[1] 

机构地区：[1]乐山市人民医院神经外科,四川乐山614400

出　　处：《华西医学》2016年第10期1671-1674,共4页West China Medical Journal

基　　金："十二五"国家科技支撑计划课题(2011 BAI 08 B 05)~~

摘　　要：目的探讨神经内镜与开颅血肿清除治疗高血压性基底节区脑出血的疗效差异。方法选取2010年1月-2014年9月收治的86例高血压性基底节区脑出血患者,随机分为内镜组和开颅组,每组各43例。内镜组在神经内镜直视下清除血肿,开颅组在手术显微镜下清除血肿。比较两组手术术中出血量,术后残余血量,血肿清除率,术前、术后7 d、术后1及3个月的神经功能缺损美国国立卫生研究院卒中量表(NIHSS)评分及巴氏指数(BI)评分变化情况,并进行统计学分析。结果内镜组术中出血量为(127±26)m L,术后残余血量为(6±4)m L,血肿清除率为(86±9)%;开颅组术中出血量为(184±41)m L,术后残余血量为(11±6)m L,血肿清除率为(72±8)%,两组比较差异均有统计学意义(P<0.05)。两组患者术前NIHSS及BI评分比较差异无统计学意义(P>0.05)。内镜组术后7 d、1和3个月NIHSS评分均低于开颅组,BI评分均高于开颅组,差异均有统计学意义(P<0.05)。结论神经内镜手术治疗高血压性基底节区脑出血具有微创、直视、血肿清除彻底、术后神经功能恢复好等优点,为基底节区脑出血的治疗提供了新的方法。Objective To explore and compare the therapeutic effects of neuro-endoscopic and craniotomic hematoma evacuation for hypertensive hematomas in the basal ganglia region.Methods Eighty-six patients with hypertensive hematomas in the basal ganglia regions treated between January 2010 and September 2014 were divided into neuro-endoscopy and craniotomy groups randomly with 43 in each.Hematoma was removed directly under neuroendoscope in the endoscopic group,while it was removed under the operating microscope in the craniotomy group.The average operation bleeding amount,residual hematoma after operation,hematoma evacuation rate,the changes of National Institutes of Health Stroke Scale（NIHSS） and Barthel index（BI） scores before operation,1 and 3 months after operation were compared between the two groups.All data were analyzed statistically.Results The average amount of operation bleeding was（127±26） mL,postoperative residual hematoma was（6±4） mL,and the hematoma clearance rate was（86±9）%in the neuro-endoscopy group,while those three numbers in the craniotomy group were respectively（184±41） mL,（11±6） mL,and（72±8）%,with all significant differences（P〈0.05）.The NIHSS and BI scores were not significantly different between the two groups before surgery（P〈0.05）.Seven days,one month and three months after surgery,the NIHSS score was significantly lower,and the BI score was significantly higher in the neuro-endoscopy group than the craniotomy group（P〈0.05）.Conclusion Neuro-endoscopic surgery for hypertensive hematomas in basal ganglia region is proved to have such advantages as mini-invasion,direct-vision,complete clearance and good neural function recovery after surgery,which is a new approach in this field.

关 键 词：神经内镜 高血压 基底节区脑出血 

分 类 号：R651.12[医药卫生—外科学]