经立体定向引导前额锁孔入路神经内镜下血肿清除术治疗高血压基底节区脑出血的短期效果  

Short-term efficacy of stereotactic-guided neuroendoscopic hematoma clearance via the forehead keyhole approach in treatment of hypertensive basal ganglia hemorrhage

作　　者：关毅[1] 任振强[1] 龙江[2] GUAN Yi;REN Zhenqiang;LONG Jiang(Department of Neurosurgery,The Second Affiliated Hospital of Henan Luohe Medical College,Luohe 462300,China)

机构地区：[1]河南漯河医学高等专科学校第二附属医院神经外科,河南漯河462300 [2]郑州大学第一附属医院神经外科

出　　处：《精准医学杂志》2024年第6期527-530,534,共5页Journal of Precision Medicine

摘　　要：目的分析经立体定向引导前额锁孔入路神经内镜下血肿清除术治疗高血压基底节区脑出血(hypertensive basal ganglia hemorrhage,HBGH)的短期效果。方法选取2016年12月—2021年8月我院神经外科HBGH患者148例,依据不同手术方案分为研究组和对照组。行常规立体定向血肿穿刺引流术的74例为对照组,行立体定向引导下前额锁孔入路神经内镜血肿清除术的74例为研究组。比较两组患者手术用时、住院期间再出血发生比例、术后6 h血肿清除比例、术前和术后3个月欧洲脑卒中量表(ESS)评分及日常生活能力(Barthel)指数、术后3个月死亡发生比例、术后3个月并发症发生比例、术后6个月预后良好比例。结果研究组手术用时长于对照组(t=19.084,P<0.05),住院期间再出血发生比例低于对照组(χ^(2)=9.378,P<0.05)。研究组患者术后6 h血肿清除比例高于对照组(u=2.935,P<0.05);术后3个月,研究组患者ESS评分、Barthel指数手术前后差值显著高于对照组(t=8.349、9.474,P<0.05),而死亡发生比例、并发症发生比例两组比较无明显差异(P>0.05);术后6个月,研究组预后良好比例高于对照组(χ^(2)=9.483,P<0.05)。结论经立体定向引导前额锁孔入路神经内镜下血肿清除术治疗HBGH手术时间虽较长,但能提高血肿清除率、降低术后再出血率,预后效果良好,并可改善患者神经功能及生活能力,且安全性高。Objective To investigate the short-term efficacy of stereotactic-guided neuroendoscopic hematoma clearance via the forehead keyhole approach in the treatment of hypertensive basal ganglia hemorrhage(HBGH).Methods A total of 148 patients with HBGH who were treated in Department of Neurosurgery in our hospital from December 2016 to August 2021 were enrolled and divided into study group and control group according to their surgical plans.The 74 patients who underwent conventional stereotactic hematoma puncture and drainage were enrolled as control group,and the 74 patients who underwent stereotactic-guided neuroendoscopic hematoma clearance via the forehead keyhole approach were enrolled as study group.The two groups were compared in terms of time of operation,the proportion of patients with rebleeding during hospitalization,the proportion of patients with hematoma clearance at 6 hours after surgery,European Stroke Scale(ESS)score and Barthel index before surgery and at 3 months after surgery,the proportion of deaths at 3 months after surgery,the proportion of patients with complications at 3 months after surgery,and the proportion of patients with good prognosis at 6 months after surgery.Results Compared with the control group,the study group had a significantly longer time of operation(t=19.084,P<0.05)and a significantly lower proportion of patients with rebleeding during hospitalization(χ^(2)=9.378,P<0.05).The study group had a significantly higher hematoma clearance rate than the control group at 6 hours after surgery(u=2.935,P<0.05);at 3 months after surgery,the study group had significantly higher difference before and after surgery ESS score and Barthel index than the control group(t=8.349,9.474,P<0.05),while there were no significant differences in mortality rate and the incidence rate of complications between the two groups(P>0.05);at 6 months after surgery,compared with the control group,the study group had a significantly higher proportion of patients with good prognosis(χ^(2)=9.483,P<0.05).Conclusion A

关 键 词：颅内出血 高血压性 立体定位技术 神经内窥镜检查 血肿 额 治疗结果 预后 

分 类 号：R743.34[医药卫生—神经病学与精神病学]