立体定向引导下前额锁孔入路神经内镜血肿清除术治疗中等量高血压基底核区脑出血的效果  

Effect of stereotactic guidance of forehead keyhole approach neuroendoscopic hematoma removal in the treatment of moderately hypertensive patients with basal ganglia cerebral hemorrhage

作　　者：赵俊涛 张敕阁 赵明亮 Zhao Juntao;Zhang Chige;Zhao Mingliang(Department of Neurosurgery,Zhengzhou Zhongkang Hospital,Zhengzhou 450000,China)

机构地区：[1]郑州中康医院神经外科,郑州450000

出　　处：《中国临床实用医学》2021年第1期38-42,共5页China Clinical Practical Medicine

摘　　要：目的探讨立体定向引导下前额锁孔入路神经内镜血肿清除术治疗中等量高血压基底核区脑出血患者的效果。方法选取2018年3月至2019年7月郑州中康医院神经外科收治的95例中等量高血压基底核区脑出血患者,男56例,女39例,年龄(60.26±3.59)岁,年龄范围为50~75岁。按照手术方式的不同分为开颅手术组(n=47)和神经内镜组(n=48)。开颅手术组行小骨瓣开颅血肿清除术联合骨瓣复位术,神经内镜组行立体定向引导下前额锁孔入路神经内镜血肿清除术,比较两组患者术后血肿清除率、手术效果、神经功能及并发症发生情况。结果神经内镜组血肿清除率[(96.23±1.99)%]高于开颅手术组[(65.23±10.23)%],差异有统计学意义(P<0.05)。两组患者手术时间比较,差异无统计学意义(P>0.05),神经内镜组瞳孔恢复时间[(48.32±7.98)h]短于开颅手术组[(53.26±8.01)h],差异有统计学意义(P<0.05),术后2周神经内镜组格拉斯哥昏迷指数(GCS)评分[(9.85±0.92)分]高于开颅手术组[(8.12±0.89)分],差异有统计学意义(P<0.05);术前两组患者美国国立卫生院神经功能缺损(NIHSS)评分比较,差异无统计学意义(P>0.05),术后1、3和6个月神经内镜组患者NIHSS评分[(22.41±3.15)分,(14.32±2.65)分,(12.03±1.95)分]均低于开颅手术组[(25.36±4.10)分,(18.32±3.37)分,(15.52±2.52)分],差异有统计学意义(P<0.05);两组患者并发症发生情况比较,差异无统计学意义(P>0.05)。结论立体定向引导下前额锁孔入路神经内镜血肿清除术通过改变切口入路途径及应用神经内镜辅助降低对神经的损伤,更好地清除血肿,从而改善治疗效果,缩短瞳孔恢复时间,不会延长手术时间及增加并发症,值得在临床上推广应用。Objective To investigate the effect of stereotactic guided forehead keyhole approach neuroendoscopic hematoma removal in the treatment of moderately hypertensive patients with basal ganglia cerebral hemorrhage.Methods From March 2018 to July 2019,95 patients with moderately hypertensive basal ganglia cerebral hemorrhage admitted to the department of Neurosurgery of Zhengzhou Zhongkang Hospital were selected.There were 56 males and 39 females,aged(60.26±3.59)years old,ranging from 50 to 75 years old.According to the surgical method,patients were divided into the combined treatment group(n=47)and the neuroendoscopy group(n=48).In the open surgery group,small bone flap craniotomy for hematoma removal combined with bone flap reduction was performed,while in the neuroendoscopy group,stereotactic guided forehead keyhole approach for neuroendoscopic hematoma removal was performed.The postoperative hematoma clearance rate,surgical effect,nerve function and complications were compared between the two groups.Results The clearance rate of hematoma in the neuroendoscopy group[(96.23±1.99)%]was higher than that of the combined treatment groups[(65.23±10.23)%],and the difference was statistically significant(P<0.05).The difference comparison of operation time between the two groups was not statistically significant(P>0.05).The pupil recovery time of the neuroendoscopy group was[(48.32±7.98)hours]which was shorter than that of the combined treatment group[(53.26±8.01)hours],and the difference was statistically significant(P<0.05),2 weeks after surgery,the Glasgow coma scale score of the neuroendoscopy group was[(9.85±0.92)points]which was higher than the combined treatment group[(8.12±0.89)points],and the difference was statistically significant(P<0.05);in the National Institutes of Health Stroke Scale(NIHSS)scores of the two groups before surgery patients had no statistically significant difference(P>0.05).The NIHSS scores after 1 month,3 months and 6 months of patients in the neuroendoscopy group[(22.41±3.15)points,(1

关 键 词：前额锁孔入路 神经内镜血肿清除术 小骨瓣开颅血肿清除术 骨瓣复位术 高血压基底核区脑出血 血肿清除率 

分 类 号：R651.12[医药卫生—外科学]