脑室外引流术与神经内镜微创手术治疗严重高血压脑室内出血的疗效比较——一项单中心回顾性研究  

A comparison of neuroendoscopic minimally invasive surgery and traditional extraventricular drainage for severe hypertensive intraventricular hemorrhage:a single-center retrospective study

作　　者：肖现 孙嘉怡 袁其俊 许芳 卢昆 梁海辉 陈志鹏 王松青 Xiao Xian;Sun Jiayi;Yuan Qijun;Xu Fang;Lu Kun;Liang Haihui;Chen Zhipeng;Wang Songqing(Department of Neurosurgery,First Naval Hospital of Southern Theater Command,Zhanjiang 524000,Guangdong,China;Department of Clinical,Medicine Xinjiang Medical University,Urumqi 830017,Xinjiang Uygur Autonomous Region,China)

机构地区：[1]南部战区海军第一医院神经外科,广东湛江524000 [2]新疆医科大学临床医学部,新疆维吾尔自治区乌鲁木齐830017

出　　处：《中国中西医结合急救杂志》2024年第3期300-303,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

摘　　要：目的分析神经内镜微创手术与传统脑室穿刺引流术治疗严重高血压脑室内出血的安全性及疗效。方法回顾性分析2020年7月至2023年7月采用神经内镜微创术式清除血肿50例(内镜组)与传统脑室外引流术治疗44例(引流组)的临床资料,观察两组血肿清除率,日常生活能力量表(ADL)分级情况,术后脑积水、继发出血、颅内感染、肺部感染发生率。结果术后内镜组患者血肿清除率大于60%患者比例和ADL分级为Ⅰ、Ⅱ、Ⅲ级者占比均明显高于引流组〔血肿清除率大于60%患者比例:88.0%(44/50)比47.7%(21/44),χ^(2)=17.794,P<0.001;ADL分级为Ⅰ、Ⅱ、Ⅲ级者占比:94.0%(47/50)比77.3%(33/44),χ^(2)=5.459,P=0.019〕,并发症发生率明显低于引流组〔8.0%(4/50)比34.1%(15/44),χ^(2)=9.879,P=0.002〕。结论与脑室外引流术相比,神经内镜微创手术治疗严重高血压脑室内出血可获得更好的治疗结果,达到较高血肿清除率,同时较少发生术后并发症。Objective To analyze the safety and efficacy of neuroendoscopic minimally invasive surgery and traditional extraventricular drainage in the treatment of severe hypertensive intraventricular hemorrhage.Methods The clinical data of 50 cases with neuroendoscopic ventricular hematoma evacuation(endoscopy group)and 44 cases with traditional ventricles external puncture drainage(drainage group)from July 2020 to July 2023 were retrospectively analyzed,and the hematoma clearance rates,classification of activities of daily living(ADL)scale,incidence of hydrocephalus,secondary bleeding,intracranial infection,and pulmonary infection were observed between the two groups of patients.Results After surgery,the proportion of patients with hematoma clearance rate>60%and ADL gradesⅠ,Ⅱ,andⅢin the endoscopy group were significantly higher than those in the drainage group[the proportion of patients with hematoma clearance rate>60%:88.0%(44/50)vs.47.7%(21/44),χ^(2)=17.794,P<0.001;the proportion of individuals with ADL gradesⅠ,Ⅱ,andⅢ:94.0%(47/50)vs.77.3%(33/44),respectively,χ^(2)=5.459,P=0.019],the incidence of complications in endoscopy group was significantly lower in the drainage group[8.0%(4/50)vs.34.1%(15/44),χ^(2)=9.879,P=0.002].Conclusion Compared with traditional ventricular puncture drainage surgery,neuroendoscopic minimally invasive surgery for the treatment of severe hypertensive intracerebral hemorrhage with ventricular casting can achieve better treatment outcomes,a higher hematoma clearance rate,and fewer postoperative complications.

关 键 词：脑室外引流术 神经内镜微创手术 高血压脑室内出血 治疗效果 

分 类 号：R651.1[医药卫生—外科学]