老年基底节区脑出血微侵袭手术治疗的临床疗效观察  

Clinical Research of Basal Ganglia Hemorrhage in the Elderly by Minimally Invasive Surgery

作　　者：袁淼 曾令勇 翟安林[1] 苟志勇 王帆 朱黎 Yuan Miao;Zeng Lingyong;Zhai Anlin(The Neurosurgical Department of Mianyang 404 Hospital,the Second Affiliated Hospital of North Sichuan Medical College,Mianyang,Sichuan 621000,China.)

机构地区：[1]四川绵阳四〇四医院·川北医学院附属第二医院神经外科,四川绵阳621000

出　　处：《四川医学》2024年第5期462-467,共6页Sichuan Medical Journal

基　　金：四川省科技厅应用基础研究项目(编号:2017JY0035)。

摘　　要：目的观察老年基底节区脑出血不同微侵袭手术方式的临床疗效。方法本研究为回顾性病例对照研究,收集2020年1月至2022年12月住院手术治疗的老年基底节区脑出血患者60例,采用神经内镜经额中回入路清除血肿的20例患者为内镜组;采用显微镜经侧裂入路清除血肿的20例患者为显微镜组;采用软通道穿刺置管引流术清除血肿的20例患者为穿刺组。观察3组患者手术时间、术中出血量、术后术区残余血肿量、术后术区再出血例数、术后手术并发症发生情况;术前术后7 d格拉斯哥昏迷评分(GCS)、美国国立卫生院卒中量表评分(NIHSS);术后6个月格拉斯哥预后评分(GOS)。结果3组患者术后7 d GCS、NIHSS评分较术前明显改善,3组间比较差异有统计学意义(P<0.05),内镜组和显微镜组明显优于穿刺组(P<0.05);3组患者术后6个月GOS评分差异有统计学意义,内镜组和显微镜组明显优于穿刺组(P<0.05);3组手术时间、术中出血量、术后术区残余血肿量差异有统计学意义(P<0.05),穿刺组手术时间、术中出血量明显小于内镜组和显微镜组(P<0.05),但穿刺组术后术区残余血肿量明显多于内镜组和显微镜组(P<0.05);穿刺组术后术区再出血例数明显多于显微镜组(P<0.05);3组术后肺部感染和泌尿道感染例数比较差异有统计学意义(P<0.05),穿刺组肺部感染、泌尿道感染、手术部位感染明显高于内镜组(P<0.05)。结论临床上要根据老年基底节区脑出血患者的具体情况选择手术方式,条件允许的情况下优先选择神经内镜直视下清除血肿,近期和远期疗效佳,术后并发症发生率低。Objective To observe clinical effects of basal ganglia hemorrhage in the elderly by minimally invasive surgery.Methods Retrospective analysis method was adopted.From January 2020 to DecembeR2022,60 basal ganglia hemorrhage elderly patients were collected.The endoscope group had 20 patients who accepted hematoma clearance by neuroendoscope through middle frontal gyrus,the microscope group had 20 patients who accepted hematoma clearance by microscope through lateral fissure,the puncture group had 20 patients who accepted hematoma clearance by soft channel puncture and catheteRdrainage.Operative time,intraoperative bleeding,postoperative residual hematoma in the operative area,postoperative rebleeding,Glasgow Coma Scale(GCS),National Institutes of Health Stroke Scale(NIHSS)before and 7 days afteRsurgery,and Glasgow Outcome Scale(GOS)6 months afteRsurgery were observed.Results GCS and NIHSS scores of three groups were significantly improved 7 days afteRoperation,which had significant difference among three groups(P<0.05).The endoscopic group and microscope group were significantly betteRthan the puncture group(P<0.05).GOS scores of three groups were significantly different 6 months afteRoperation,and the endoscopy group and microscope group were significantly betteRthan the puncture group(P<0.05).The operation time,intraoperative hemorrhage and postoperative residual hematoma in three groups were significantly different(P<0.05).The operation time and intraoperative hemorrhage in puncture group were significantly less than those in endoscopic group and microscope group(P<0.05),but the postoperative residual hematoma in puncture group was significantly more than those in endoscopic group and the microscope group(P<0.05).The numbeRof postoperative rebleeding cases in puncture group was significantly higheRthan that in microscope group(P<0.05).There was significant difference in postoperative pulmonary infection and urinary tract infection among three groups(P<0.05).The puncture group had significantly higheRpulmonary in

关 键 词：神经内镜 额中回 显微镜 侧裂 穿刺 基底节区 脑出血 

分 类 号：R651.1[医药卫生—外科学]