神经内镜微创与小骨窗开颅显微手术治疗高血压脑出血及其不同部位血肿的疗效  

Effect of neuroendoscopic minimally invasive and small bone window craniotomy in treatment of hypertensive cerebral hemorrhage and application effect of different hematoma sites

作　　者：赵朝辉[1] 阳建国[1] 钟兴明[1] 汪一棋[1] 蔡勇[1] 费振海 张磊[1] 杨涛[1] 顾华[1] ZHAO Chao-hui;YANG Jian-guo;ZHONG Xing-ming(Department of Neurosurgery,Huzhou First People's Hospital,Huzhou 313000,China)

机构地区：[1]湖州市第一人民医院神经外科,湖州313000

出　　处：《临床神经外科杂志》2021年第5期572-576,共5页Journal of Clinical Neurosurgery

基　　金：2018年湖州市科技计划立项项目(2018GYB64)。

摘　　要：目的探讨神经内镜微创与小骨窗开颅显微手术治疗高血压脑出血及其不同部位血肿的疗效。方法96例高血压脑出血患者根据电脑随机方式分为小骨窗开颅显微手术组(开颅组)和神经内镜微创手术组(内镜组),每组48例;同时又根据血肿是否位于基底节区深部,将各组患者分为深部组和表浅组亚组。对比分析两种手术方式患者的手术相关指标、临床疗效、术后并发症、日常生活能力量表(ADL)评分、美国国立卫生研究院卒中量表(NIHSS)评分。同时对比不同血肿部位患者的血肿清除率、ADL评分、总体并发症发生率及再出血率。结果内镜组患者的皮肤切口长度、骨窗大小、手术时间、术中出血量均少于开颅组,血肿清除率高于开颅组,总有效率及并发症发生率均优于开颅组,术后1、3、6个月ADL评分及术后7 d、1、3个月NIHSS评分均优于开颅组,差异有统计学意义(P<0.05~0.001)。内镜-深部组患者的血肿清除率、术后ADL评分高于开颅-深部组,且再出血率、总体并发症发生率低于开颅-深部组(P<0.05~0.001);内镜-表浅组患者的总体并发症发生率低于开颅-表浅组(P<0.05),而血肿清除率、术后ADL评分及再出血率与开颅-表浅组的差异无统计学意义(均P>0.05)。结论神经内镜微创手术能减少高血压患者手术创伤,有效清除血肿,是一种治疗高血压脑出血的有效手段,值得临床推广应用。Objective To investigate the efficacy of minimally invasive neurosurgery and small bone window craniotomy in the treatment of hypertensive intracerebral hemorrhage and hematoma in different parts.Methods 96 patients with hypertensive intracerebral hemorrhage were randomly divided into small bone window craniotomy microsurgery group(craniotomy group)and neuroendoscopic minimally invasive surgery group(Endoscopy Group),48 cases in each group.At the same time,the patients were divided into deep group and superficial group according to whether the hematoma was located in the deep part of basal ganglia.The operation related indexes,clinical efficacy,postoperative complications,activities of daily living(ADL)score and National Institutes of Health Stroke Scale(NIHSS)score were compared and analyzed.At the same time,hematoma clearance rate,ADL score,overall complication rate and rebleeding rate of patients with different hematoma sites were compared.Results The length of skin incision,size of bone window,operation time and intraoperative blood loss of the endoscopic group were less than those of the craniotomy group.The hematoma clearance rate of the endoscopic group was higher than that of the craniotomy group.The total effective rate and complication rate of the endoscopic group were better than those of the craniotomy group.The ADL score at 1,3 and 6 months after operation and the NIHSS score at 7 days,1 and 3 months after operation were better than those of the craniotomy group,and the differences were statistically significant(P<0.05-0.001).The hematoma clearance rate and postoperative ADL score of endoscopic deep group were higher than those of craniotomy deep group,and the rebleeding rate and overall complication rate were lower than those of craniotomy deep group(P<0.05-0.001).The overall complication rate of endoscopic superficial group was lower than that of craniotomy superficial group(P<0.05),but there was no significant difference in hematoma clearance rate,ADL score and rebleeding rate between endoscopic s

关 键 词：神经内镜 微创手术 开颅显微手术 高血压脑出血 血肿位置 疗效 

分 类 号：R651[医药卫生—外科学] R544.1[医药卫生—临床医学]