神经内镜手术治疗高血压脑出血破入脑室的临床分析  

Clinical analysis of neuroendoscopic surgery for the treatment of hypertensive intracerebral hemorr-hage breaking into the ventricle

作　　者：王亮[1] 王维[1] 怀鹏[1] 陈聪[1] 王溪 贺伟光 赵新亮[3] 高飞 陈镭[1] Wang Liang;Wang Wei;Huai Peng;Chen Cong;Wang Xi;He Weiguang;Zhao Xinliang;Gao Fei;Chen Lei(Department of Neurosurgery,Tianjin Fifth Central Hospital,Tianjin 300450,China;Department of Imaging,Tianjin Fifth Central Hospital,Tianjin 300450,China;Department of Neurosurgery,Tianjin Yongjiu Hospital,Tianjin 300450,China)

机构地区：[1]天津市第五中心医院神经外科,天津300450 [2]天津市第五中心医院影像科,天津300450 [3]天津市永久医院神经外科,天津300450

出　　处：《中华神经外科杂志》2023年第2期140-144,共5页Chinese Journal of Neurosurgery

基　　金：京津冀专项(H2018206675);天津市滨海新区卫生计生委科技项目(2017BWKY035)。

摘　　要：目的探讨神经内镜手术治疗高血压脑出血破入脑室的手术方法和治疗效果。方法回顾性分析2017年1月至2021年1月天津市第五中心医院神经外科收治的16例高血压脑出血破入脑室患者的临床资料。所有患者均行神经内镜手术治疗。术后进行门诊或电话随访,以改良Rankin量表评分(mRS)和格拉斯哥预后评分(GOS)评估患者的预后。观察患者的并发症发生情况。结果16例患者的手术时长为(132.8±32.9)min(90~190 min)。术后24 h的血肿清除率为(80.6±10.6)%。1例术后再次发生脑出血后死亡。15例患者术后随访6个月,GOS为(3.2±1.1)分(1~5分),mRS为(3.6±1.6)分(1~5分)。随访期间发生脑积水1例。结论神经内镜手术治疗高血压脑出血破入脑室具有操作时间短、血肿清除率高、远期脑积水发生率低的优点。Objective To investigate the surgical method and therapeutic outcome of neuroendoscopic surgery for hypertensive intracerebral hemorrhage breaking into the ventricle.Methods A retrospective analysis was conducted on the clinical data of 16 patients with hypertensive intracerebral hemorrhage breaking into the ventricle who were admitted to the Department of Neurosurgery,Tianjin Fifth Central Hospital from January 2017 to January 2021.All patients underwent neuroendoscopic surgery.Outpatient or telephone follow-up was conducted after operation,and the outcome of patients was evaluated by modified Rankin scale(mRS)and Glasgow Outcome scale(GOS).The patients′complications were observed and documented.Results The operation time of 16 patients was 132.8±32.9 min(90-190 min).The hematoma clearance rate at 24 hours after operation was 80.6%±10.6%.One case died after cerebral hemorrhage occurred again after operation.After 6 months of follow-up,the GOS was 3.2±1.1 points(1-5 points),and the mRS was 3.6±1.6 points(1-5 points).One case of hydrocephalus occurred during the follow-up period.Conclusions Neuroendoscopic surgery can be an effective treatment for hypertensive intracerebral hemorrhage breaking into the ventricle.The technique is associated with short operation time,high hematoma clearance rate,and low incidence of chronic hydrocephalus.

关 键 词：颅内出血 高血压性 自然腔道内镜手术 治疗结果 脑室 基底神经节 

分 类 号：R651.1[医药卫生—外科学]