神经内镜在高血压脑出血破入脑室手术中的应用  

The application of neuroendoscopy in the surgery of hypertensive intracerebral hemorrhage breaking into the ventricles

作　　者：余文运[1] 祝圆圆 唐宁 张占伟[1] 喻坚柏[1] 曾劲松[1] 陈涛[1] 罗刚[1] Yu Wenyun;Zhu Yuanyuan;Tang Ning;Zhang Zhanwei;Yu Jianbai;Zeng Jinsong;Chen Tao;Luo Gang(Department of Neurosurgery,the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine,Changsha 410007,Hunan,China)

机构地区：[1]湖南中医药大学第一附属医院神经外科,长沙410007

出　　处：《中国现代手术学杂志》2023年第3期237-241,共5页Chinese Journal of Modern Operative Surgery

基　　金：长沙市自然科学基金项目(kq2208200);湖南省卫健委科研计划项目(D202304099020);湖南省中医药管理局科研计划项目(B2023023)。

摘　　要：目的探讨神经内镜治疗高血压脑出血破入脑室的临床疗效。方法回顾性分析我院神经外科于2019年1月至2022年9月收治的64例高血压脑出血破入脑室患者的临床资料,其中神经内镜组32例,侧脑室引流联合尿激酶组(简称侧脑室引流组)32例。观察两种手术方式的手术时间、住院天数、血肿清除率、并发症发生率及术后恢复情况。结果神经内镜组的手术时间长于侧脑室引流组,为(122.03±24.53)min vs.(89.69±13.84)min,住院天数短于侧脑室引流组,为(12.81±3.68)d vs.(19.00±5.40)d,P=0.000。神经内镜组血肿清除率为78.31%±8.00%,高于侧脑室引流组的51.50%±11.63%,P=0.000。神经内镜组术后脑积水发生率较侧脑室引流组低,为12.5%(4/32)vs.34.4%(11/32),P=0.039。术后随访6个月,对患者术后恢复情况进行电话回访,发现神经内镜组格拉斯哥预后评分(Glasgow outcome score,GOS)高于侧脑室引流组;改良Rankin量表评分(modified Rankin scale,mRS)低于侧脑室引流组(P=0.000)。结论神经内镜下血肿清除术的手术时间相对较长,但临床效果更好,清除颅内血肿更全面,术后脑积水发生率低,能较好地改善患者预后。Objective To explore the clinical efficacy of neuroendoscopy in the treatment of hypertensive intracerebral hemorrhage breaking into the ventricles.Methods A retrospective analysis was conducted on the clinical data of 64 patients with hypertensive intracerebral hemorrhage breaking into the ventricles from January 2019 to January 2023.Among them,32 cases were in the neuroendoscopic group and 32 cases were in the lateral ventricular drainage combined with urokinase group(referred to as the lateral ventricular drainage group).The surgical time,length of hospital stay,hematoma clearance rate,complication rates and postoperative recovery of the two surgical methods were compared.Results The surgical time of the neuroendoscopic group was longer than that of the lateral ventricular drainage group,which was(122.03±24.53)minutes vs.(89.69±13.84)minutes,and the hospital stay was shorter than that of the lateral ventricular drainage group,which was(12.81±3.68)days vs.(19.00±5.40)days,P=0.000.The clearance rate of the neuroendoscopic group was 78.31%±8.00%,which was higher than 51.50%±11.63%of the lateral ventricular drainage group,P=0.000.The incidence of postoperative hydrocephalus was lower than the lateral ventricular drain-age group,which was 12.5%(4/32)vs.34.4%(11/32),P=0.039.Telephone follow-up was con-ducted to assess the postoperative recovery of the patients for 6 months.It was found that the Glasgow outcome score(GOS)in the neuroendoscopic group was higher than that in the lateral ventricular drainage group;The modified Rankin scale(mRS)was lower than that of the lateral ventricular drainage group(P=0.000).Conclusion Neuroendoscopic hematoma removal surgery has relatively long surgical time,but its clinical effect is better.It can comprehensively remove intracranial hematoma,reduce postopera-tive hydrocephalus,and improve the patients'prognosis.

关 键 词：神经内镜 侧脑室外引流术 高血压脑出血 脑室 颅内血肿清除术 

分 类 号：R651.1[医药卫生—外科学]