3种手术方法治疗自发性幕上脑出血的临床疗效分析  

Clinical efficacy of 3 surgical methods for spontaneous supratentorial intracerebral hemorrhage

作　　者：宋平[1] 李知阳 雷盼 华秋伟 高论 江洪祥 周龙 叶晖[1] 陈谦学[1] 蔡强[1] Song Ping;Li Zhiyang;Lei Pan;Hua Qiuwei;Gao Lun;Jiang Hongxiang;Zhou Long;Ye Hui;Chen Qianxue;Cai Qiang(Department of Neurosurgery,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院神经外科,武汉430060

出　　处：《中华神经医学杂志》2025年第2期154-162,共9页Chinese Journal of Neuromedicine

基　　金：国家自然科学基金(82271518)。

摘　　要：目的探讨3种手术方法治疗自发性幕上脑出血(SSICH)的手术效果及术后再出血、脑水肿情况。方法回顾性纳入武汉大学人民医院神经外科自2018年12月至2021年10月收治的294例SSICH患者为研究对象。根据手术方法不同将患者分为神经内镜血肿清除组(126例)、立体定向钻孔引流组(98例)、开颅血肿清除组(70例)。分析3组患者的手术效果及并发症发生情况,其中术后残余血肿、水肿体积情况基于3D Slicer软件进行量化计算。结果神经内镜血肿清除组、立体定向钻孔引流组、开颅血肿清除组患者的血肿清除率分别为86.25%±2.27%、44.45%±3.61%、75.45%±2.89%,出院时格拉斯哥昏迷量表评分分别为(13.51±1.28)分、(11.24±2.17)分、(10.25±2.56)分,术后再出血发生率分别为16.1%、26.0%、22.9%,术后残余血肿体积分别为(18.90±12.33)mL、(25.75±11.43)mL、(22.91±7.93)mL,术后水肿峰值体积分别为(37.43±11.07)mL、(39.54±9.43)mL、(42.26±10.94)mL,术后3~5 d时达水肿高峰者比例分别为31.0%、65.3%、68.6%,术后第7天时水肿带直径分别为(20.04±2.98)mm、(24.12±5.85)mm、(23.59±3.81)mm,术后9~11 d、12~14 d时水肿明显消退者比例分别为45.2%、24.5%、42.9%及76.2%、57.1%、62.9%,其中神经内镜血肿清除组与其他2组的差异均有统计学意义(P<0.05)。结论相对于立体定向钻孔引流、开颅血肿清除术,神经内镜手术可以更有效地清除SSICH患者的血肿并降低术后再出血、脑水肿的发生。Objective To investigate the clinical efficacy and major complications(postoperative hemorrhage and cerebral edema)of 3 surgical methods in spontaneous supratentorial intracerebral hemorrhage(SSICH).Methods A retrospective analysis was performed;294 patients with SSICH admitted to Department of Neurosurgery,Renmin Hospital of Wuhan University from December 2018 to October 2021 were selected.According to different surgical methods,these patients were divided into neuroendoscopic hematoma removal group(n=126),stereotactic drilling and drainage group(n=98),and craniotomy hematoma removal group(n=70).The surgical efficacy and complications in the 3 groups were analyzed,and the postoperative residual hematoma and edema volumes were quantitatively calculated based on 3D Slicer software.Results The hematoma evacuation rate in the neuroendoscopic hematoma removal group,stereotactic drilling and drainage group,and craniotomy hematoma removal group was 86.25%±2.27%,44.45%±3.61%,and 75.45%±2.89%,respectively;Glasgow coma Scale scores at discharge were 13.51±1.28,11.24±2.17 and 10.25±2.56,respectively;postoperative hemorrhage incidence was 16.1%,26.0%and 22.9%,respectively;postoperative residual hematoma volume was(18.90±12.33)mL,(25.75±11.43)mL and(22.91±7.93)mL,and postoperative peak edema volume was(37.43±11.07)mL,(39.54±9.43)mL,and(42.26±10.94)mL,respectively;percentage of patients with peak edema on 3-5 days after surgery was 31.0%,65.3%and 68.6%;the diameter of edema zone was(20.04±2.98)mm,(24.12±5.85)mm and(23.59±3.81)mm,respectively,on 7 days after surgery;percentage of patients with edema resolution was 45.2%,24.5%,42.9%and 76.2%,57.1%,62.9%,respectively,on 9-11 days and 12-14 days after surgery;these indexes in the neuroendoscopic hematoma removal group were significantly different compared with those in the other two groups(P<0.05).Conclusion Compared with stereotactic drilling and drainage or craniotomy hematoma removal,neuroendoscopic surgery can effectively remove the hematoma and reduce the occu

关 键 词：脑出血 自发性幕上脑出血 神经内镜 术后再出血 脑水肿 

分 类 号：R651.12[医药卫生—外科学]