基底节区高血压脑出血锁孔内镜和立体定向置管联合尿激酶引流术式疗效的比较  

Keyhole Approach Endoscopic Surgery versus Stereotactic Aspiration plus Urokinase in Treating Basal Ganglia Hypertensive Intracerebral Hemorrhage

作　　者：毛锦龙 徐永革 罗永春 张国珍 梁明 胡野风 沈春森 MAO Jinlong;XU Yongge;LUO Yongchun;ZHANG Guozhen;LIANG Ming;HU Yefeng;SHEN Chunsen(Department of Neurosurgery,the 7 th Medical Center,Chinese PLA General Hospital,Beijing 100700,China)

机构地区：[1]中国人民解放军总医院第七医学中心神经外科,北京100700

出　　处：《中国医学科学院学报》2020年第4期513-520,共8页Acta Academiae Medicinae Sinicae

摘　　要：目的比较锁孔开颅神经内镜下血肿清除(KAES)与立体定向置管联合尿激酶引流(SAU)两种微创术式在治疗基底节区高血压脑出血患者中的近期和远期效果。方法回顾分析117例患者(KAES组63例、SAU组54例),比较两组手术时间、失血量、引流管留置时长。评估术后超早期、早期和短期的残留血肿体积、血肿清除率、格拉斯哥昏迷评分(GCS)和美国国立卫生研究院卒中量表评分(NIHSS),评估术后30 d死亡率和严重并发症及术后6个月的改良Rankin评分(mRS)。结果两组术前基线数据差异无统计学意义。KAES组较SAU组手术时间更长、失血量更多、引流管留置时间更短(P均<0.001);术后超早期KAES组血肿清除率更高(P<0.001);而术后早期及短期两组血肿清除率差异无统计学意义(P均>0.05)。术后超早期和早期,两组GCS和NIHSS差异无统计学意义(P均>0.05);术后短期SAU组NIHSS优于KAES组(P=0.034)。术后30 d死亡率及严重并发症两组比较差异无统计学意义(P均>0.05);术后6个月mRS≤3分者两组比较差异无统计学意义(P=0.413)。结论两种术式治疗基底节区脑出血均安全有效,KAES术后超早期血肿清除率及残留血量占优,随后SAU组快速追赶并与KAES组相当,SAU组近期和远期效果均不亚于KAES。Objective To compare the short-and long-term effect of two minimal invasive surgical therapies including keyhole approach endoscopic surgery(KAES)and stereotactic aspiration plus urokinase(SAU)in treating basal ganglia hypertensive intracerebral hemorrhage(hICH).Methods The clinical data of 117 hICH patients(63 received KAES and 54 received SAU)were retrospectively analyzed.The operation time,blood loss during surgery,and drainage time were compared between two groups.The residual hematoma volume,hematoma clearance rate(HCR),Glasgow coma scale(GCS)score,and National Institute of Health Stroke Scale(NIHSS)score were recorded at baseline and in the ultra-early stage,early stage,and sub-early stage after surgery.The 30-day mortality and serious adverse events were assessed and the 6-month modified Rankin scale(mRS)score was rated.Results Baseline data showed no significant difference between these two groups.Compared with the SAU group,the KAES group had significantly longer operation time,more intraoperative blood loss,and shorter drainage time(all P<0.001).In the ultra-early stage after surgery,HCR was significantly higher in the KAES group(P<0.001),whereas in the early and sub-early stage,HCR showed no significant differences(all P>0.05).In the ultra-early and early stage,the GCS and NIHSS scores showed no significant differences between two groups(all P>0.05),whereas in the sub-early stage,the NIHSS score was better in the SAU group(P=0.034).The 30-day mortality and incidences of serious adverse events showed no significant difference(all P>0.05).The good recovery(mRS≤3)at 6-months follow-up showed no significant difference between the two groups(P=0.413).Conclusions Both KAES and SAU are safe and effective in treating basal ganglia hICH.In the ultra-early stage after surgery,KAES achieves better residual hematoma volume and HCR,and patients undergoing SAU quickly catch up.The short-and long-term effectiveness of SAU is comparable or even superior to KAES.

关 键 词：高血压脑出血 内镜手术 立体定向穿刺 尿激酶 

分 类 号：R743.34[医药卫生—神经病学与精神病学]