MR-DTI参数评估神经内镜手术与微创钻孔引流术治疗中等量基底节区脑出血  

Neuroendoscopic surgery and minimally invasive drilling and drainage in the treatment of moderate basal ganglia cerebral hemorrhage based on MR-DTI parameters

作　　者：刘彬[1] 崔述坤 高祥亮 张刚[1] 杜国良[1] 宋建抢 LIU Bin;CUI Shukun;GAO Xiangliang;ZHANG Gang;DU Guoliang;SONG Jianqiang(Cangzhou Central Hospital,Cangzhou 061000,China)

机构地区：[1]沧州市中心医院,河北沧州061000

出　　处：《中国实用神经疾病杂志》2023年第11期1343-1348,共6页Chinese Journal of Practical Nervous Diseases

基　　金：沧州市科技计划自筹经费项目(编号:213106082)。

摘　　要：目的探究磁共振弥散张量成像技术(MR-DTI)参数评估神经内镜手术与微创钻孔引流术治疗中等量基底节区脑出血患者的临床效果。方法选取沧州市中心医院神经外科2022-01—2022-06收治的80例基底节区脑出血患者,分为内镜组(40例)和钻孔组(40例),内镜组采用神经内镜手术治疗,钻孔组采用微创钻孔引流术治疗。术后3个月行MR-DTI检查计算各向异性分数(FA)值,记录2组患者术中出血量、手术时间、脑血肿清除率及术后2周内并发症发生率。随访3个月,记录患者病死率,并采用格拉斯哥预后(GOS)评分评估患者预后。结果内镜组和钻孔组治疗后FA值分别为(0.54±0.02)×10^(-3)mm^(2)/s、(0.61±0.03)×10^(-3)mm^(2)/s,2组术后患侧FA值均低于术前,内镜组低于钻孔组(P<0.05)。内镜组和钻孔组术中出血量分别为(61.04±8.95)mL、(10.29±2.14)mL,手术时间分别为(104.63±18.59)min、(29.86±7.48)min,血肿清除率分别为(88.39±15.42)%、(71.06±7.59)%,内镜组术中出血量、手术时间、血肿清除率均高于钻孔组(P<0.05)。内镜组和钻孔组颅内感染发生率分别为2.50%、15.00%,术后病死率分别为7.50%、10.00%,GOS评分分别为(3.96±0.71)分、(4.35±0.69)分,内镜组颅内感染发生率低于钻孔组(P<0.05);2组术后病死率比较差异无统计学意义(P>0.05);内镜组GOS评分低于钻孔组(P<0.05)。FA值与GOS评分呈显著正相关(r=0.572,P<0.05)。结论神经内镜手术治疗有助于提高患者脑血肿清除率,但术中创伤较大,而微创钻孔引流术应用于中等量基底节区脑出血治疗中,术中创伤更小,更有助于促进患者恢复。MR-DTI定量参数可用于评估中等量基底节区脑出血患者的神经功能且与预后密切相关。Objective To evaluate the clinical effect of neuroendoscopic surgery and minimally invasive drilling and drainage in the treatment of patients with moderate cerebral hemorrhage in the basal ganglia region by diffusion tensor imaging(MR-DTI)parameters.Methods Eighty patients with intracerebral hemorrhage in the basal ganglia region admitted to Department of Neurosurgery,Cangzhou Central Hospital from January 2022 to June 2022 were selected and randomly divided into the endoscopic group(40 cases)and the drilling group(40 cases).The endoscopic group was treated by neuroendoscopic surgery,and the drilling group was treated by minimally invasive drilling and drainage.MR-DTI was performed 3 months after operation to calculate the anisotropy score(FA),and the intraoperative bleeding volume,operation time,clearance rate of cerebral hematoma and complication rate within 2 weeks after operation were recorded.Patients were followed up for 3 months,the mortality rate was recorded,and the prognosis was assessed by Glasgow outcome scale(GOS)score.Results The FA values of the endoscopic group and the drilling group after treatment were(0.54±0.02)×10^(-3)mm^(2)/s,(0.61±0.03)×10^(-3)mm^(2)/s,respectively the postoperative FA values of the affected side in both groups were lower than before surgery,while the endoscopic group was lower than the drilling group(P<0.05).The intraoperative bleeding volume in the endoscopic group and the drilling group were(61.04±8.95)mL and(10.29±2.14)mL,respectively.The surgical time was(104.63±18.59)min and(29.86±7.48)min,respectively.The hematoma clearance rate was(88.39±15.42)%and(71.06±7.59)%,respectively.The intraoperative bleeding volume,hand surgery time,and hematoma clearance rate in the endoscopic group were higher than those in the drilling group(P<0.05).The incidence of intracranial infection was 2.50%in the endoscopic group and 15.00%in the drilling group,and the postoperative mortality rate was 7.50%and 10.00%,respectively.The GOS score was(3.96±0.71)points and(4.35±0.69)point

关 键 词：基底节区脑出血 神经内镜手术 微创钻孔引流术 弥散张量成像 

分 类 号：R743.34[医药卫生—神经病学与精神病学]