神经内镜辅助手术治疗丘脑出血破入脑室的临床疗效  

Clinical Effect of Neuroendoscopy-assisted Operation for the Treatment of Thalamic Hemorrhage Rupture into the Ventricle

作　　者：刘西书 杨文明 苗野 杨智鑫 张振兴 Liu Xishu;Yang Wenming;Miao Ye;Yang Zhixin;Zhang Zhenxing(Department of Neurosurgery,the First Affiliated Hospital of Jinzhou Medical University,Jinzhou 121000 China)

机构地区：[1]锦州医科大学附属第一医院神经外科,辽宁锦州121000

出　　处：《锦州医科大学学报》2023年第4期66-70,共5页Journal of Jinzhou Medical University

基　　金：辽宁省教育厅优秀人才支持计划,项目编号:LJQ2013088。

摘　　要：目的探索神经内镜辅助丘脑血肿清除术联合同侧脑室外引流术与丘脑血肿引流联合对侧脑室外引流术治疗丘脑出血破入脑室(thalamic hemorrhage rupture into the ventricle,THRIV)的临床效果。方法选择锦州医科大学附属第一医院2020年9月至2022年6月的丘脑出血破入脑室患者73例,依不同手术治疗方式分为观察组(38例,行神经内镜辅助丘脑血肿清除术联合同侧脑室外引流术治疗)与对照组(35例,行丘脑血肿引流联合对侧脑室外引流术治疗),比较两组患者术后第3天血肿清除率、手术时长及术中的出血量、住院时长及费用、术后并发症及脑水肿情况、术后1 w格拉斯哥昏迷量表(glasgow coma scale,GCS)评分及术后3个月格拉斯哥预后量表(glasgow prognosis scale,GOS)评分。结果两组患者术前的各项指标差异无统计学意义(P>0.05)。观察组手术时长、术中出血量、住院花费和术后第3天血肿清除率均大于对照组,但其住院时间较对照组短,均有统计学意义(P<0.05)。观察组术后脑积水、颅内感染、肺部感染几率较对照组低(P<0.05);两组患者在再出血、癫痫、术后死亡和消化道出血方面差异无统计学意义(P>0.05)。观察组患者术后第3天脑水肿CT评分(BECTS)明显较对照组高,但其术后1 w BECTS较对照组低,差异均存在统计学意义(P<0.05)。观察组患者术后1 w GCS及术后3个月GOS评分均大大超过对照组(P<0.05)。结论神经内镜辅助丘脑血肿清除术联合同侧脑室外引流术可提高患者的血肿清除率,缩减住院时间和术后脑水肿的持续时间。减少术后脑积水、颅内感染和肺部感染的发生率,改善患者的3个月预后。Objective To explore the clinical effect of neuroendoscopy-assisted thalamic hematoma removal combined with ipsilateral external ventricular drainage(EVD)and thalamic hematoma puncture drainage(HPD)+contralateral EVD in the treatment of thalamic hemorrhage rupture into the ventricle(THRIV).Methods 73 patients with thalamic hemorrhage rapture into the ventricle were selected from the First Affiliated Hospital of Jinzhou Medical University from September 2020 to June 2022.According to different surgical treatment methods,they were divided into the observation group(38 cases were treated with neuroendoscopy-assisted removal of thalamic hematoma combined with ipsilateral external ventricular drainage)and the control group(35 cases were treated with thalamic hematoma drainage+contralateral external ventricular drainage).Hematoma clearance rate on the 3rd day after surgery,operation duration and amount of blood loss during operation,length and cost of hospital stay,postoperative complications and cerebral edema,Glasgow Coma Scale(GCS)score 1 w after surgery and Glasgow Prognosis Scale(GOS)score 3 months after surgery were compared between the two groups.Results There was no statistical difference in preoperative indexes between the two groups(P>0.05).The operation duration,intraoperative blood loss,hospitalization cost and hematoma clearance rate on the 3rd day after operation in the observation group were higher than those in the control group,but the hospitalization time was shorter than that in the control group,with statistical significance(P<0.05).The incidence of postoperative hydrocephalus,intracranial infection and pulmonary infection in the observation group was lower than that in the control group(P<0.05);there were no significant differences in rebleeding,epilepsy,postoperative death and gastrointestinal bleeding between the two groups(P>0.05).Cerebral edema CT score(BECTS)in observation group was significantly higher than that in control group on the 3rd day after surgery,but BECTS at 1 w after surgery was

关 键 词：神经内镜 脑室外引流 丘脑出血 治疗效果 预后 

分 类 号：R651[医药卫生—外科学]