神经内镜结合两种引流手术对重症脑室出血患者临床疗效及近期预后比较  

Comparison of hematoma clearance,postoperative complications and short-term prognosis in patients with severe intraventricular hemorrhage by neuroendoscopy combined with two drainage operations

作　　者：徐占义 孙昭胜[1] 徐敏[2] 赵宝帅 毛建辉[1] 魏建辉 XU Zhanyi;SUN Zhaosheng;XU Min;ZHAO Baoshuai;MAO Jianhui;WEI Jianhui(Department of Neurosurgery, Harrison International Peace Hospital, Hengshui People's Hospital, Hengshui 053000, Hebei, China;Department of Preventive Health, Harrison International Peace Hospital, Hengshui People's Hospital, Hengshui 053000, Hebei, China)

机构地区：[1]哈励逊国际和平医院·衡水市人民医院神经外科,河北衡水053000 [2]哈励逊国际和平医院·衡水市人民医院预防保健科,河北衡水053000

出　　处：《西部医学》2020年第6期859-862,867,共5页Medical Journal of West China

基　　金：衡水市科技计划项目(2016014108Z)。

摘　　要：目的比较神经内镜结合两种引流术对重症脑室出血患者血肿清除、术后并发症及近期预后。方法回顾性分析2013年12月~2017年12月神经外科收治的282例脑室出血患者,根据手术方式分为2组,内镜组130例给予神经内镜结合腰大池引流手术,钻孔组152例采取钻孔引流术。手术结束,比较术后血肿清除率、术后并发症及近期预后情况。结果内镜组术后住院时间、术中出血量均短于钻孔组,差异有统计学意义(P<0.05);两组术后1、2、7 d的脑实质血肿清除率比较无差异(P>0.05);术后1、2、7 d,内镜组脑室内血肿清除率明显高于钻孔组,差异有统计学意义(P<0.05);手术结束后,内镜组发生脑积水、感染的情况明显低于钻孔组,差异有统计学意义(P<0.05)。对所有患者随访6个月,内镜组预后不良率为21.54%,明显低于钻孔组的32.24%(P<0.05);内镜组术后6个月后的日常生活能力(ADL)评分低于钻孔组,GOS评分高于钻孔组,差异均有统计学意义(P<0.05)。结论神经内镜结合腰大池引流手术应用于重症脑室出血患者治疗,可彻底清除血肿,降低颅内感染风险,有助改善患者预后,优于钻孔引流术。Objective To compare effects of neuroendoscopy combined with lumbar cistern drainage and drilling drainage on hematoma clearance,postoperative complications and short-term prognosis in patients with severe ventricular hemorrhage(SVH).Methods 282 patients with ventricular hemorrhage admitted to neurosurgery department of the hospital from December 2013 to December 2017 were retrospectively analyzed.According to different surgical methods,they were divided into two groups.The 130 patients in endoscopy group were treated with neuroendoscopy combined with lumbar cistern drainage,while 152 patients in drilling group were treated with drilling drainage.At the end of surgery,postoperative hematoma clearance rate,postoperative complications and short-term prognosis were compared.ResultsThe postoperative hospitalization time and intraoperative blood loss in endoscopy group were shorter than those in drilling group(P<0.05).After 1d,2d and 7d of surgery,there was no difference in hematoma clearance rate of brain parenchyma between the two groups(P>0.05).After 1d,2d and 7d of surgery,hematoma clearance rate of brain parenchyma in endoscopy group was significantly higher than that in drilling group(P<0.05).At the end of surgery,incidence of hydrocephalus and infection in endoscopy group was significantly lower than that in drilling group(P<0.05).All patients were followed up for 6 months.The poor prognosis rate in endoscopy group was significantly lower than that in drilling group(21.54%vs 32.24%)(P<0.05).After 6 months of surgery,ADL score in endoscopy group was lower than that in drilling group,while GOS score was higher than that in drilling group(P<0.05).Conclusion The application of neuroendoscopy combined with lumbar cistern drainage in treatment of SVH patients can completely remove hematoma and reduce risk of intracranial infection,which can help improve prognosis of patients.

关 键 词：重症脑室出血 神经内镜 腰大池引流 钻孔引流术 血肿 预后 

分 类 号：R743.34[医药卫生—神经病学与精神病学]