神经内镜微创手术降低自发性脑室出血后慢性脑积水的临床研究  

Clinical study of endoscopic evacuation of spontaneous intraventricular hemorrhage to reduce secondary chronic hydrocephalus

作　　者：孙瑾[1] 龚娅丽 韦诗凯 陈锷[1] 刘忠 黄延林[1] SUN Jin;GONG Yali;WEI Shikai;CHEN E;LIU Zhong;HUANG Yanlin(Department of Neurosurgery,Zhongshan Hospital Affiliated to Xiamen University,Xiamen 361004,China)

机构地区：[1]厦门大学附属中山医院神经外科,厦门361004

出　　处：《临床神经外科杂志》2024年第6期660-663,667,共5页Journal of Clinical Neurosurgery

基　　金：国家青年科学基金项目(82101403);厦门市医疗卫生指导性项目(3502Z20209034,3502Z20214ZD1045)。

摘　　要：目的 探讨神经内镜微创手术降低自发性脑室出血(IVH)后慢性脑积水的临床研究。方法 回顾性分析2020年9月-2022年9月厦门大学附属中山医院收治的157例自发性IVH患者,分为引流组、显微镜组、神经内镜组,比较三组患者的术前格拉斯哥昏迷指数(GCS)评分、术前改良格拉斯哥昏迷指数(mGS)评分、Evan's指数、24 h血肿清除率、手术时间、住院时间、并发症发生情况、死亡率、出院时GCS评分、mRS预后评分、出院时Evan's指数以及手术后6个月脑积水发生率。结果 与引流组和显微镜组相比,神经内镜组的血肿清除率、出院时GCS评分显著升高(P<0.05),手术时间、住院时间、并发症发生率、死亡率、出院时Evan's指数、出院时mRS评分和手术后6个月脑积水发生率明显降低(P<0.05)。结论 自发性IVH采用神经内镜手术治疗能快速清除大部分血肿,显著减少慢性脑积水发生率,有效防止IVH后慢性脑积水的发生。Objective To investigate endoscopic evacuation of spontaneous intraventricular hemorrhage(IVH)to reduce secondary chronic hydrocephalus.Methods A retrospective analysis was performed for 157 patients with spontaneous IVH admitted to Zhongshan Hospital Affiliated to Xiamen University from September 2020 to September 2022.They were divided into drainage group,microscope group,and neuroendoscopic group.Preoperative Glasgow coma scale(GCS)scores,preoperative modified Glasgow coma scale(mGS)scores,Evan s index,24-hour hematoma clearance rate,surgery time,hospital stay,complications,mortality rate,discharge GCS score,mRS prognostic score,Evan s index,and incidence of hydrocephalus at 6 months after surgery of three groups were compared.Results Compared with the drainage group and the microscope group,the hematoma clearance rate and GCS score at discharge in the neuroendoscopic group were significantly increased(P<0.05),while the surgical time,hospitalization time,incidence of complications,mortality rate,Evan s index at discharge,mRS score at discharge,and incidence of hydrocephalus at 6 months after surgery were significantly reduced(P<0.05).Conclusions Spontaneous IVH can be treated with neuroendoscopic surgery to quickly remove most of the hematoma,significantly reduce the incidence of chronic hydrocephalus,and effectively prevent the occurrence of chronic hydrocephalus after IVH.

关 键 词：脑室出血 神经内镜 脑积水 临床研究 

分 类 号：R739.41[医药卫生—肿瘤]