老年幕上高血压性脑出血患者神经内镜手术与开颅手术安全性和有效性比较  

Safety and effectiveness of neuroendoscopic surgery versus craniotomy for supratentorial intracerebral hemorrhage in elderly hypertensive patients

作　　者：邹福建 蒋登志 李洋[1] Zou Fujian;Jiang Dengzhi;Li Yang(Department of Neurosurgery,Bishan People's Hospital·Bishan Hospital of Chongqing Medical University,Chongqing 402760,China)

机构地区：[1]重庆医科大学附属璧山医院(重庆市璧山区人民医院)神经外科,402760

出　　处：《中华老年心脑血管病杂志》2024年第10期1197-1200,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：重庆市璧山区指导性科研项目(2019-10)。

摘　　要：目的 探讨3D-slicer软件辅助神经内镜手术和开颅手术对老年幕上高血压性脑出血患者的安全性和有效性。方法 回顾性选择2020年1月至2022年12月重庆市璧山区人民医院神经外科收治的老年幕上高血压性脑出血患者150例,根据手术方法不同分为内镜组82例和开颅组68例,观察2组临床手术情况(手术时间,术中出血量,血肿清除率)和预后情况(重症监护时间,格拉斯哥昏迷量表评分,术后再出血,院内死亡)。结果 内镜组与开颅组患者手术时间、术中出血量、术后再出血及院内病死率比较,差异无统计学意义(P>0.05)。与开颅组比较,内镜组血肿清除率明显增高[(84.73±6.49)%vs(78.94±7.12)%,P=0.000]。与开颅组比较,内镜组重症监护时间明显缩短[(5.38±1.48)d vs(7.32±1.26)d,P=0.000],术后7 d和3个月格拉斯哥昏迷量表评分明显增高[(12.66±0.83)分vs(11.82±0.97)分,P=0.000;(13.72±1.27)分vs(13.05±0.98)分,P=0.001]。与开颅组比较,内镜组总并发症发生率明显降低(4.9%vs 16.2%,P=0.022)。结论 3D-slicer软件辅助神经内镜手术可以显著改善老年幕上高血压性脑出血患者术后神经功能,降低并发症发生率。Objective To compare the safety and efficacy of 3D-slicer software assisted neuroendoscopic surgery and craniotomy for elderly patients with supratentorial intracerebral hemorrhage(ICH) due to hypertension.Methods A total of 150 elderly hypertensive patients with supratentorial ICH admitted in our department from January 2020 to December 2022 were enrolled,and according to their approaches,they were divided into an endoscopic group(n=82) and a craniotomy group(n=68).Clinical surgical status(operation time,intraoperative bleeding volume and hematoma clearance rate) and prognosis(length of ICU stay,GCS score,postoperative rebleeding,and in-hospital mortality) were observed and compared between the two groups of patients.Results There were no statistical differences between the two groups in terms of operation time,intraoperative bleeding volume,postoperative rebleeding,or in-hospital mortality(P>0.05).The endoscopic group had significantly higher hematoma clearance rate [(84.73±6.49)% vs(78.94±7.12)%,P=0.000],shorter length of ICU stay [(5.38±1.48)d vs(7.32±1.26)d,P=0.000],higher GCS scores in 7 d and 3 months after surgery(12.66±0.83 vs 11.82±0.97,P=0.000;13.72±1.27 vs 13.05±0.98,P=0.001),and lower total incidence of complications(4.9% vs 16.2%,P=0.022) when compared with the endoscopic group.Conclusion 3D-slicer software assisted neuroendoscopic surgery can significantly improve postoperatively neurological function and reduce the incidence of complications in elderly hypertensive patients with supratentorial ICH.

关 键 词：高血压 脑出血 格拉斯哥昏迷量表 神经外科手术 

分 类 号：R651.1[医药卫生—外科学]