立体定向软通道与硬通道抽吸手术治疗原发性脑干出血的疗效对比分析  

Comparative analysis of stereotactic soft-channel and hard-channel aspiration in the treatment of primary brainstem hemorrhage

作　　者：李岩 纪乐 陈凌友 吴冬雪 李亚雄 李聪慧 Li Yan;Ji Le;Chen Lingyou;Wu Dongxue;Li Yaxiong;Li Conghui(Department of Neurosurgery,the First Hospital of Hebei Medical University,Shijiazhuang 050000,China;Department of Radiology and Nuclear Medicine,the First Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第一医院神经外科,石家庄050000 [2]河北医科大学第一医院放射与核医学科,石家庄050000

出　　处：《中华神经外科杂志》2024年第8期804-809,共6页Chinese Journal of Neurosurgery

基　　金：河北省卫健委医学科学研究课题(20200120,20231036)。

摘　　要：目的对比分析立体定向软通道与硬通道抽吸手术治疗原发性脑干出血的疗效。方法回顾性对比分析2014年8月至2023年8月河北医科大学第一医院神经外科采用立体定向软通道抽吸手术(65例,软通道组)与硬通道抽吸手术(81例,硬通道组)治疗的146例原发性脑干出血患者的临床资料。术后即刻复查头颅CT评估残余血肿量,记录术后血肿腔引流管的留置时长,随访术后30 d患者的生存状态、术后90 d改良Rankin量表评分(mRS)及格拉斯哥预后分级(GOS);以mRS 0~3分为神经功能恢复良好,以GOSⅣ~Ⅴ级为预后良好。结果软通道组与硬通道组患者的性别、年龄、术前格拉斯哥昏迷评分(GCS)等基线资料的差异均无统计学意义(均P>0.05)。所有患者的手术均顺利完成。无术后再出血患者,无其他手术相关并发症。与软通道组比较,硬通道组患者术后即刻残余血肿量[M(Q_(1),Q_(3))]较小[0(0,0.3)ml对比3.5(0.5,4.4)ml,Z=-7.54,P<0.001]、术后血肿腔引流管的留置时长较短[1(1,2)d对比3(2,4)d,Z=-7.09,P<0.001]、术后30 d病死率较低[14.8%(12/81)对比41.5%(27/65),χ^(2)=20.19,P=0.035]、神经功能恢复良好者占比较高[32.1%(26/81)对比18.5%(12/65),χ^(2)=4.78,P=0.047];但两组术后90 d的预后情况差异无统计学意义(χ^(2)=6.28,P=0.189)。结论与立体定向软通道抽吸手术比较,硬通道抽吸手术治疗原发性脑干出血可更好地清除血肿,降低患者术后残余血肿量和病死率,并改善神经功能。Objective To comparatively analyze the efficacy of stereotactic soft-channel aspiration surgery and hard-channel aspiration surgery in treating primary brainstem hemorrhage.Methods We retrospectively analyzed the clinical data of 146 patients with primary brainstem hemorrhage who were treated with stereotactic soft-channel aspiration surgery(n=65,soft-channel group)and hard-channel aspiration surgery(n=81,hard-channel group)at the Department of Neurosurgery of the First Hospital of Hebei Medical University from August 2014 to August 2023.Postoperative immediate head CT scan was performed to evaluate residual hematoma volume,and the duration of postoperative hematoma cavity drainage tube placement was documented.Follow-up assessments included the survival status of patients at 30 days post-operation,and the modified Rankin Scale(mRS)and Glasgow Outcome Scale(GOS)grades at 90 days post-operation.The mRS scores of 0-3 were considered as good neurological recovery,and GOS gradesⅣ-Ⅴas favorable outcomes.Results There were no statistically significant differences between the soft-channel and hard-channel groups in terms of gender,age,or preoperative Glasgow Coma Scale(GCS)scores(all P>0.05).All surgeries were successfully completed without postoperative rebleeding or other surgery-related complications.Compared with the soft-channel group,the hard-channel group had a significantly smaller immediate postoperative residual hematoma volume[M(Q_(1),Q_(3)):0(0,0.3)ml vs.3.5(0.5,4.4)ml,Z=-7.54,P<0.001],shorter duration of postoperative hematoma cavity drainage tube placement[M(Q 1,Q 3):1(1,2)d vs.3(2,4)d,Z=-7.09,P<0.001],lower mortality rate at 30 days post-operation[14.8%(12/81)vs.41.5%(27/65),χ^(2)=20.19,P=0.035],and a higher proportion of patients with good neurological recovery[32.1%(26/81)vs.18.5%(12/65),χ^(2)=4.78,P=0.047].However,there was no statistically significant difference in the outcome at 90 days post-operation between the two groups(χ^(2)=6.28,P=0.189).Conclusion Hard-channel aspiration surgery for pri

关 键 词：脑出血 脑干 立体定位技术 抽吸 对比研究 

分 类 号：R651.12[医药卫生—外科学]