对比分析显微镜下经侧裂清除术与神经内镜下经额叶清除术治疗中老年大量基底节区脑出血的疗效  

Comparison and analysis of microscopical lateral fissure clearance and neuroendoscopic frontal lobe clearance in the treatment of massive basal ganglia intracerebral hemorrhage in the middle-aged and elderly

作　　者：明兴[1] 杜海 曹垒[1] 许洪升[1] 徐武 王天男 MING Xing;DU Hai;CAO Lei(Department of Neurosurgery,Xuzhou Central Hospital,Xuzhou Jiangsu 221000,China)

机构地区：[1]徐州市中心医院神经外科,江苏徐州221000 [2]南京鼓楼医院神经外科,江苏南京210000

出　　处：《临床和实验医学杂志》2023年第7期695-699,共5页Journal of Clinical and Experimental Medicine

基　　金：江苏省第十五批“六大人才高峰”高层次人才选拔培养资助项目(编号:WSN-135)。

摘　　要：目的对比研究显微镜下经侧裂清除术与神经内镜下经额叶清除术治疗中老年大量基底节区脑出血(ICH)的疗效。方法回顾性选取2019年1月至2022年1月徐州市中心医院收治的中老年大量基底节区脑出血患者60例,根据手术方式不同分为显微手术组(显微镜下经侧裂清除术)和内镜组(神经内镜下经额叶清除术),每组30例。评价并比较两组的围术期情况、炎症因子、预后效果、并发症及临床疗效等差异。结果内镜组手术时间、皮层切口长度、术中出血量、术后住院天数以及总体并发症发生率为(1.91±0.67)h、(3.06±0.57)cm、(79.71±14.07)mL、(15.15±3.31)d、40.00%,均低于显微手术组[(2.53±0.84)h、(5.14±0.81)cm、(134.90±21.08)mL、(20.12±5.11)d、73.33%],而血肿清除率为(90.42±6.28)%,显著高于显微手术组[(82.35±12.57)%],差异均有统计学意义(P<0.05)。内镜组术后24 h血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)和降钙素原水平为(37.05±4.49)μg/L、(47.82±7.13)ng/L、(3.53±0.37)μg/L,均低于显微手术组[(50.34±6.12)μg/L、(58.93±9.05)ng/L、(4.42±0.50)μg/L],差异均有统计学意义(P<0.05)。与术前相比,两组术后各观测点美国国立卫生研究院卒中量表(NIHSS)评分下降,Barthel指数(BI)评分显著升高,而内镜组NIHSS评分低于显微手术组,BI评分高于显微手术组,差异均有统计学意义(P<0.05)。两组治疗总有效率差异无统计学意义(P>0.05),但内镜组愈显率为86.67%,显著高于显微手术组(63.33%),差异有统计学意义(P<0.05)。结论显微镜下经侧裂清除术与神经内镜下经额叶清除术均是中老年大量基底节区脑出血的有效治疗方式,但后者在减少手术创伤、提高血肿清除率、促进神经功能恢复、抑制炎症反应、预防并发症方面更具优势。Objective To compare the therapeutic effects of microscopical lateral fissure clearance and neuroendoscopic frontal lobectomy in the treatment of massive basal ganglia intracerebral hemorrhage in the middle-aged and elderly.Methods Sixty middle-aged and elderly patients with massive basal ganglia intracerebral hemorrhage admitted to Xuzhou Central Hospital from January 2019 to January 2022 were retrospectively divided into microsurgery group(microsurgery via lateral fissure clearance)and endoscopic group(neurosurgery via frontal lobe clearance)according to different surgical methods,with 30 patients in each group.The differences in perioperative conditions,inflammatory factors,prognosis,complications,and clinical efficacy between the two groups were evaluated and compared.Results The operation time,incision length,intraoperative bleeding,postoperative hospital stay and overall complication rate in the endoscopic group were(1.91±0.67)h,(3.06±0.57)cm,(79.71±14.07)mL,(15.15±3.31)d,and 40.00%,which were lower than those in the microsurgery group[(2.53±0.84)h,(5.14±0.81)cm,(134.90±21.08)mL,(20.12±5.11)d,and 73.33%],while the hematoma clearance rate was(90.42±6.28)%,which was higher than that in the microsurgery group[(82.35±12.57)%],and the differences were statistically significant(P<0.05).The levels of serum tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and procalcitonin in endoscopic group were(37.05±4.49)μg/L,(47.82±7.13)ng/L,(3.53±0.37)μg/L,which were lower than those in microsurgery group[(50.34±6.12)μg/L,(58.93±9.05)ng/L,(4.42±0.50)μg/L]at 24 h after operation,and the differences were statistically significant(P<0.05).Compared with pre operation,National Institute of Health stroke scale(NIHSS)scores at each observation point in the two groups decreased and Barthel Index(BI)scores increased after operation,while NIHSS score in endoscopic group was lower than that in microsurgery group,and BI score was higher than that in microsurgery group,and the differences were statistically signific

关 键 词：显微镜下经侧裂清除术 神经内镜下经额叶清除术 大量基底节区脑出血 中老年患者 疗效 

分 类 号：R651.1[医药卫生—外科学]