经额平行白质纤维束立体定向血肿穿刺引流术与神经内镜下血肿清除术治疗基底节脑出血的临床对比分析  

Clinical comparative analysis of stereotactic puncture and drainage of hematoma through frontal parallel white matter fiber tracts and hematoma evacuation under neuroendoscopy in the treatment of basal ganglia intracerebral hemorrhage

作　　者：张志超 李陈 韩惠 周夏[1] 洪家康 Zhichao Zhang;Chen Li;Hui Han;Xia Zhou;Jiakang Hong(Department of Neurosurgery,the People's Hospital of Ma'anshan,Ma'anshan 243000,China)

机构地区：[1]马鞍山市人民医院神经外科,安徽马鞍山243000

出　　处：《中华神经创伤外科电子杂志》2024年第5期299-303,共5页Chinese Journal Of Neurotraumatic Surgery:Electronic Edition

基　　金：马鞍山市医疗卫生领域科技计划(YL-2022-4);安徽省临床医学研究转化专项项目(202204295107020060)

摘　　要：目的对比分析经额平行白质纤维束立体定向血肿穿刺引流术与神经内镜下血肿清除术治疗基底节脑出血的临床疗效。方法回顾性收集马鞍山市人民医院神经外科自2020年6月至2024年4月收治的45例基底节脑出血患者的临床资料。根据治疗方式将患者分为立体定向组(经额平行白质纤维束立体定向血肿穿刺引流术,31例)和神经内镜组(神经内镜下血肿清除术,14例)。比较2组患者的手术时间、术中出血量、术后残余血肿量,术后脑水肿情况、术后日常生活活动能力(ADL)评分、改良Rankin量表(mRS)评分及并发症发生情况。结果立体定向组术中出血量、术后脑水肿体积显著少于神经内镜组,术后6 h的血肿量多于神经内镜组,差异有统计学意义(P<0.05)。2组患者的手术时间、术后3 d血肿量、并发症、术后再出血比较,差异无统计学意义(P>0.05)。立体定向组的白质纤维束保护、术后1个月的ADL评分、术后3个月mRS评分均优于神经内镜组,差异有统计学意义(P<0.05)。结论经额平行白质纤维束立体定向血肿穿刺引流术在术中出血量、术后脑水肿及预后方面均优于神经内镜下血肿清除术,并能减少患者大脑白质纤维束损害。Objective To compare and analyze the clinical efficacy of stereotactic puncture and drainage of hematoma through frontal parallel white matter fiber and hematoma evacuation under neuroendoscopy in the treatment of basal ganglia intracerebral hemorrhage.Methods A total of 45 patients with basal ganglia intracerebral hemorrhage admitted to Neurosurgery Department of Ma’anshan People’s Hospital from June 2020 to April 2024 were collected.According to the treatment method,patients were divided into the stereotactic group(31 patients underwent stereotactic hematoma puncture and drainage via frontal parallel white matter fiber bundle)and the neuroendoscopic group(14 patients underwent endoscopic hematoma removal).The operation time,intraoperative blood loss,postoperative residual hematoma volume,postoperative brain edema,postoperative activities of daily living(ADL)score and modified Rankin scale(mRS)score,and complications were compared between two groups.Results The intraoperative bleeding and postoperative brain edema volume in the stereotactic group were significantly less than those in the neuroendoscopy group,and the hematoma volume at 6 h after surgery was greater than that in the neuroendoscopy group,with statistical significance(P<0.05).There was no statistically significant difference in the surgical time,postoperative 3-day hematoma volume,complications,and postoperative rebleeding between two groups(P>0.05).The white matter tract protection,ADL score at 1 month after surgery,and mRS score at 3 months after surgery in the stereotactic group were all better than those in the neuroendoscopy group,and the differences were statistically significant(P<0.05).Conclusion Transfrontal parallel white matter fiber tract stereotactic hematoma puncture and drainage is superior to neuroendoscopic hematoma removal in terms of intraoperative blood loss,postoperative brain edema and prognosis,and can reduce the damage of cerebral white matter fiber tracts.

关 键 词：基底节脑出血 立体定向 神经内镜 白质纤维束 

分 类 号：R651.1[医药卫生—外科学]