内镜辅助锁孔入路与大骨瓣开颅清除脑内血肿的对比  

Comparison of endoscope-assisted keyhole approach and large trauma craniotomy for evacuation of intracerebral hematoma

作　　者：陈祥涛 王鹏 孙荣伟 杨允学 许真 付莛凯 张玉海 孙国庆 Chen Xiangtao;Wang Peng;Sun Rongwei;Yang Yunxue;Xuzhen;Fu Tingkai;Zhang Yuhai;Sun Guoqing(Department of Neurosurgery, Rizhao Central Hospital, Rizhao, Shandong 276800, China;Department of Rehabilitationy, Rizhao People's Hospital Affiliated to Jining Medical College, Rizhao, Shandong 276800, China;Department of Neurosurgery, Rizhao People's Hospital Affiliated to Jining Medical College, Rizhao, Shandong 276800, China)

机构地区：[1]日照市中心医院神经外科,276800 [2]济宁医学院附属日照市人民医院康复科,276800 [3]济宁医学院附属日照市人民医院神经外科,276800

出　　处：《中国微侵袭神经外科杂志》2019年第9期398-401,共4页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：济宁医学院教师科研扶持基金（编号：JY2017FS031)

摘　　要：目的对比内镜锁孔入路与大骨瓣开颅清除脑内血肿两种手术方式的治疗效果。方法回顾性分析89例高血压性脑出血(HICH)病人的临床资料,按手术方式不同分为内镜锁孔入路组46例和大骨瓣开颅组43例。对比两组治疗效果,并进行随访。结果与大骨瓣开颅组比较,内镜锁孔入路组手术时间明显缩短(P<0.01),术中出血量明显减少(P<0.01),均不需要术中输血。另外,内镜锁孔入路组术后血肿清除率明显高于大骨瓣开颅组(P<0.01),而重度水肿率明显低于大骨瓣开颅组(P<0.05)。术后随访6个月,内镜锁孔入路组预后良好率明显优于大骨瓣开颅组(P<0.01),而两组病死率及再出血率无明显差异(P>0.05)。结论内镜辅助锁孔入路具有创伤小、疗效好的优点,术中微牵拉技术和最短时间内清除脑内血肿是内镜辅助锁孔入路术后神经功能恢复良好的重要因素。Objective To compare the therapeutic effect of endoscope-assisted keyhole approach and large trauma craniotomy for evacuation of intracerebral hematoma. Methods Clinical data of 89 patients with hypertensive intracerebral hemorrhage(HICH) were analyzed retrospectively. The patients were divided into endoscope-assisted keyhole approach group(keyhole group, n=46) and large trauma craniotomy group(craniotomy group, n=43) according to the different surgical methods. The therapeutic effect of the two groups was compared and follow-up performed. Results Compared with the craniotomy group, the surgical duration was shortened and the amount of bleeding decreased significantly(P<0.01), the evacuation rate of the hematoma was significantly higher(P<0.01), and severe edema rate significantly lower in the keyhole group(P<0.05), and intraoperative blood transfusion was not required. During a follow-up period of 6 months, the rate of good prognosis in keyhole group was significantly superior to that of craniotomy group(P<0.01), and there was no significant difference in mortality and rebleeding rate between the two groups(P>0.05). Conclusions It is small invasive and well effective for HICH patients by endoscope-assisted keyhole approach, and intraoperative micropull technique and intracerebral hematoma removal in the shortest time are critical factors for good recovery of neurological function.

关 键 词：颅内出血 高血压性 锁孔入路 内镜 颅骨切开术 

分 类 号：R651.1[医药卫生—外科学] R743.34[医药卫生—临床医学]