组织扩张器辅助神经内镜微创手术治疗基底节区高血压脑出血对神经认知功能及预后的影响  

Effects of Neuroendoscopic Minimally Invasive Surgery Assisted with Tissue Expander on Neurocognitive Function and Prognosis of Patients with Hypertensive Intracerebral Hemorrhage of Basal Ganglia

作　　者：王宏涛 丁玲 孙青龙 梁绍栋 WANG Hongtao;DING Ling;SUN Qinglong;LIANG Shaodong(Department of Neurosurgery,Mudanjiang Forestry Center Hospital,Mudanjiang,Heilongjiang 157000,China;Department of Neurology,Mudanjiang Forestry Center Hospital,Mudanjiang,Heilongjiang 157000,China;Department of Interventional Medicine,Mudanjiang Forestry Center Hospital,Mudanjiang,Heilongjiang 157000,China;Department of Neurosurgery,Hongqi Hospital,Mudanjiang Medical College,Mudanjiang,Heilongjiang 157000,China)

机构地区：[1]牡丹江林业中心医院神经外科,黑龙江牡丹江157000 [2]牡丹江林业中心医院神经内科,黑龙江牡丹江157000 [3]牡丹江林业中心医院介入科,黑龙江牡丹江157000 [4]牡丹江医学院附属红旗医院神经外科,黑龙江牡丹江157000

出　　处：《临床误诊误治》2025年第6期68-72,共5页Clinical Misdiagnosis & Mistherapy

基　　金：黑龙江省省属高等学校基本科研业务费科研项目(2020-KYYWF-0758)。

摘　　要：目的探讨应用组织扩张器辅助神经内镜微创手术治疗基底节区高血压脑出血(HICH)对患者认知功能及预后的影响。方法选取2020年9月至2023年6月收治的基底节区HICH患者82例,采用随机数字表法分为观察组和对照组各41例。对照组采用传统开颅血肿清除术治疗,观察组采用组织扩张器辅助神经内镜微创手术治疗。比较2组围术期指标、血肿清除情况和术前、术后3个月神经功能和认知功能评分及并发症发生率;比较2组术后6个月格拉斯哥预后(GOS)评分分级及预后良好率。结果与对照组比较,观察组切口长度短,术中出血量和骨窗面积小,手术和住院时间短(P<0.01);观察组术后残余血肿量少于对照组,血肿清除率高于对照组(P<0.01);术后3个月,观察组美国国立卫生研究院卒中量表评分低于对照组,洛文斯顿认知功能评定和日常生活活动能力量表评分高于对照组(P<0.05,P<0.01);观察组术后并发症总发生率[4.88%(2/41)]低于对照组[19.51%(8/41)],差异有统计学意义(P<0.05);术后随访6个月,2组患者GOS评分分级比较差异有统计学意义(P<0.01);观察组预后良好率[85.36%(35/41)]高于对照组[65.85%(27/41)],差异有统计学意义(P<0.05)。结论组织扩张器辅助下神经内镜微创手术治疗基底节区HICH的神经认知功能和预后均优于传统开颅血肿清除术。Objective To explore the effects of neuroendoscopic minimally invasive surgery assisted with tissue expander on neurocognitive function and prognosis of patients with hypertensive intracerebral hemorrhage(HICH)of basal ganglia.Methods According to random number table method,82 patients with HICH of basal ganglia admitted between September 2020 and June 2023 were divided into observation group(n=41)and control group(n=41).The control group was treated with traditional craniotomy evacuation of hematoma,while the observation group was treated with neuroendoscopic minimally invasive surgery assisted with tissue expander.The perioperative indexes,evacuation of hematoma,scores of neurological function and cognitive function at 3 months after surgery,incidence of complications,grading of Glasgow outcome scale(GOS)score and good prognosis rate at 6 months after surgery were compared between the two groups.Results Compared with control group,incision length was shorter in observation group,intraoperative blood loss and bone window area were lower or smaller,and the duration of operation and length of hospitalization were shorter(P<0.05).After surgery,residual hematoma volume in observation group was less than that in control group,and hematoma clearance rate was higher than that in control group(P<0.01).At 3 months after surgery,score of National Institutes of Health Stroke Scale in observation group was lower than that in control group,and scores of the Lovington Cognitive Function Assessment and Activities of Daily Living Scale were higher than those in control group(P<0.05,P<0.01).The total incidence of postoperative complications in observation group was lower than that in control group[4.88%(2/41)vs.19.51%(8/41),P<0.05].After 6 months of postoperative follow-up,there were significant differences in grading of GOS scores between the two groups(P<0.01).The good prognosis rate in observation group was higher than that in control group[85.36%(35/41)vs.65.85%(27/41),P<0.05].Conclusion Compared with traditional craniotomy

关 键 词：颅内出血 高血压性 神经内镜手术 组织扩张器 格拉斯哥预后评分 洛文斯顿认知功能评定 手术后并发症 

分 类 号：R743.34[医药卫生—神经病学与精神病学]