硬性脑内镜辅助手术治疗脑室出血血肿铸型的疗效分析  

Analysis of the therapeutic effect of rigid endoscope assisted surgery in the treatment of intraventricular hemorrhage and hematoma cast

作　　者：李华泉 陶国荣 温剑峰 许海泽 邓磊 龚存林 秦荣 Huaquan Li;Guorong Tao;Jianfeng Wen;Haize Xu;Lei Deng;Cunlin Gong;Rong Qin(Department of Neurosurgery,the 908th Hospital of the Joint Logistic Support Force of the Chinese People's Liberation Army,Nanchang 330002,China;Department of External Medicine,Wannian County Traditional Chinese Medicine Hospital,Wannian 335500,China)

机构地区：[1]解放军联勤保障部队第九〇八医院神经外科,江西南昌330002 [2]万年县中医院外一科,江西万年335500

出　　处：《中华脑科疾病与康复杂志(电子版)》2024年第6期353-358,共6页Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition)

基　　金：江西省卫生健康委普通科技计划项目(SKJP220226361);解放军联勤保障部队第九〇八医院苗子基金(2022YNKT001)

摘　　要：目的分析硬性脑内镜辅助手术技术治疗脑室出血血肿铸型的临床效果。方法回顾性分析解放军联勤保障部队第九〇八医院神经外科自2016年2月至2023年2月经手术治疗的81例脑室出血血肿铸型患者的临床资料。按照手术是否应用硬性脑内镜辅助技术分为脑内镜组(41例)与对照组(40例)。脑内镜组采用在硬性脑内镜辅助下行脑室血肿清除并镜下直视侧脑室置管外引流手术治疗,对照组采用传统盲穿双额入路行双侧侧脑前角置管外引流手术治疗。比较2组患者的术后血肿清除情况、GCS评分、引流管拔管时间及并发症发生情况等。随访6个月,采用日常生活能力量表评估患者的预后。结果2组患者治疗2周后的GCS评分较治疗前升高,且脑内镜组优于对照组,差异均有统计学意义(P<0.05)。脑内镜组拔管时间短于对照组,差异有统计学意义(P<0.05)。脑内镜组患者的即时血肿清除率达50%以上,术后5 d的血肿清除率(88.51%±7.74%)高于对照组(66.52%±10.38%),术后并发症发生率(21.95%)低于对照组(42.50%),预后良好率(65.85%)高于对照组(35.00%),差异均有统计学意义(P<0.05)。结论在硬性脑内镜辅助下清除脑室内血肿并镜下直视侧脑室置管引流的手术方式精准可靠,引流和颅内压缓解效果好,血肿清除率高,同时置管时间显著缩短,临床并发症发生率显著降低,可作为脑室出血血肿铸型的手术治疗选择。Objective To study the clinical application effect of rigid endoscopic assisted surgery technique in ventriculorrhagia and hematoma molding surgery.Methods A retrospective analysis was conducted on the clinical data of 81 patients with ventriculorrhagia and hematoma molding who underwent surgical treatment in the Neurosurgery Department of the 908th Hospital of the Joint Logistic Support Force of the Chinese People&apos;s Liberation Army from February 2016 to February 2023.According to whether the surgical technique applied rigid endoscopic assisted technology,the patients were divided into endoscope group(n=41)and control group(n=40).The control group underwent traditional blind double frontal approach for bilateral lateral ventricle anterior horn external drainage surgery,while the endoscope group underwent rigid endoscopic assisted ventriculorrhagia clearance and lateral ventricle anterior horn external drainage surgery under direct vision.The postoperative hematoma clearance,GCS score changes,drainage tube removal time,and complications were compared between the two groups.Follow-up for 6 months,activity of daily living scale(ADL)was used to evaluate the patient&apos;s prognosis.Results The GCS scores of the two groups were higher than those before treatment after 2 weeks of treatment,and the brain endoscopy group was better than that of the control group,and the difference was statistically significant(P<0.05).The extubation time in the brain endoscopy group was shorter than that in the control group,and the difference was statistically significant(P<0.05).The immediate hematoma clearance rate of the patients in the brain endoscopy group was more than 50%,and the hematoma clearance rate(88.51%±7.74%)on the 5th day after surgery was higher than that of the control group(66.52%±10.38%),the incidence of postoperative complications(21.95%)was significantly lower than that of the control group(42.50%),and the rate of excellent clinical efficacy(65.85%)was significantly higher than that of the control group(35.0

关 键 词：脑出血 脑室铸型血肿 脑内镜 疗效 

分 类 号：R651.1[医药卫生—外科学]