神经内镜手术对幕上高血压性脑出血患者的疗效分析:一项单中心回顾性病例对照研究  

Efficacy analysis of neuroendoscopic surgery in patients with supratentorial hypertensive intracerebral hemorrhage:a single center,retrospective,case-control study

作　　者：张敏敏[1] 吴涛[1] 吴雄枫 沈红健[1] 朱宣[1] 吕楠[1] 徐小龙 ZHANG Minmin;WU Tao;WU Xiongfeng;SHEN Hongjian;ZHU Xuan;LYU Nan;XU Xiaolong(Neurovascular Center,The First Affiliated Hospital of Naval Medical University(Second Military Medical University),Shanghai 200433,China)

机构地区：[1]海军军医大学(第二军医大学)第一附属医院脑血管病中心,上海200433

出　　处：《海军军医大学学报》2024年第4期421-426,共6页Academic Journal of Naval Medical University

基　　金：海军军医大学(第二军医大学)校级课题(2022QN053)。

摘　　要：目的探讨神经内镜手术治疗幕上高血压性脑出血的效果。方法回顾性选择2022年1-12月我中心收治的42例幕上高血压性脑出血手术患者,根据治疗方式分为神经内镜组(22例)和开颅手术组(20例)。对比两组患者术后残余血肿量、术后90 d预后良好(改良Rankin量表评分为0~3分)率、死亡率及并发症发生率。结果神经内镜组术后残余血肿量<15 mL的患者比例(77.3%,17/22)高于开颅手术组(35.0%,7/20;P=0.022)。神经内镜组和开颅手术组术后90 d预后良好的患者分别为14例(63.6%)和4例(20.0%),差异有统计学意义(P<0.001)。神经内镜组术后再出血发生率(4.5%,1/22)低于开颅手术组(5.0%,1/20;P=0.001)。两组患者术后肺部感染发生率均为100.0%,差异无统计学意义(P=1.000)。神经内镜组的术后90 d死亡率(13.6%,3/22)低于开颅手术组(30.0%,6/20;P<0.001)。结论神经内镜手术治疗可提高幕上高血压性脑出血患者的血肿清除率,降低并发症发生率及死亡率,改善患者预后。Objective To investigate the effect of neuroendoscopic surgery on supratentorial hypertensive intracerebral hemorrhage.Methods Totally 42 patients with supratentorial hypertensive intracerebral hemorrhage treated in our center from Jan.to Dec.2022 were retrospectively enrolled and divided into neuroendoscopic group(n=22)and craniotomy group(n=20)according to the treatment methods.The volume of residual hematoma,the rate of good prognosis 90 d after operation(modified Rankin scale score was 0-3),mortality,and complication incidence were compared between the 2 groups.Results The proportion of patients with postoperative residual hematoma less than 15 mL in the neuroendoscopic group(77.3%,17/22)was significantly higher than that in the craniotomy group(35.0%,7/20;P=0.022).In the neuroendoscopic group and craniotomy group,14(63.6%)patients and 4(20.0%)patients had good prognoses 90 d after operation,respectively,with significant difference(P<0.001).The incidence of postoperative rebleeding was significantly lower in the neuroendoscopy group(4.5%,1/22)than that in the craniotomy group(5.0%,1/20;P=0.001).The incidence of postoperative pulmonary infection in both groups was 100%,without significant difference(P=1.000).The 90 d mortality was significantly lower in the neuroendoscopic group(13.6%,3/22)than that in the craniotomy group(30.0%,6/20;P<0.001).Conclusion Neuroendoscopic surgery can improve the hematoma clearance rate,reduce complication incidence and mortality,and improve the prognosis of patients.

关 键 词：神经内镜手术 开颅手术 脑出血 幕上高血压性脑出血 预后 

分 类 号：R651.1[医药卫生—外科学]