经额穿刺联合神经内镜治疗高血压性基底节区脑出血临床效果研究  

Effect of transfrontal puncture combined with neuroendoscopy onhypertensive basal ganglia cerebral hemorrhage

作　　者：陆波 莫永彪 李成才 黄源[1] 龙飞[1] 康睿[1] 唐雄伟[1] 贾孝军 LU Bo;MO Yongbiao;LI Chengcai;HUANG Yuan;LONG Fei;KANG Rui;TANG Xiongwei;JIA Xiaojun(Department of Neurosurgery,Hechuan District Peopel′s Hospital of Chongqing,Chongqing 401520,China)

机构地区：[1]重庆市合川区人民医院神经外科,重庆401520

出　　处：《现代医药卫生》2025年第3期630-633,637,共5页Journal of Modern Medicine & Health

基　　金：重庆市合川区科学技术委员会基金项目(HCKJ-2022-53)。

摘　　要：目的 探讨经额穿刺联合神经内镜经额叶清除术与显微镜经侧裂清除术治疗高血压性基底节区脑出血的疗效。方法 选取2022年6月至2023年12月该院收治的高血压性基底节区脑出血患者70例,根据不同手术方式分为内镜治疗组(采用经额穿刺联合神经内镜经额叶清除术)和显微手术组(采用显微镜经侧裂清除术),每组35例。评价2组患者手术情况(包括术中失血量、手术时间、术后24 h血肿清除率、术后住院时间,以及术后1、5 d颅内压水平)、术后并发症(包括术后区再出血、颅内感染、肺部感染、硬膜下积液和术后癫痫)、预后效果(术后14 d格拉斯哥昏迷评分、术后30 d美国国立卫生研究院卒中量表评分和术后3个月Barthel指数评分)等。结果 内镜治疗组患者术中失血量、手术时间、术后住院时间、并发症总发生率均明显低于显微手术组,血肿清除率明显高于显微手术组,差异均有统计学意义(P<0.05)。2组患者术前,术后1、5 d颅内压比较,差异均无统计学意义(P>0.05);2组患者术后1、5 d颅内压均较术前明显降低,差异均有统计学意义(P<0.05)。与术前比较,2组患者术后14 d格拉斯哥昏迷评分、术后3个月Barthel指数评分均明显升高,术后30 d美国国立卫生研究院卒中量表评分均明显降低,且内镜治疗组患者各时间点升高或降低变化较显微手术组更明显,差异均有统计学意义(P<0.05)。内镜治疗组患者并发症总发生率明显低于显微手术组,差异有统计学意义(P<0.05);2组患者各种并发症发生率比较,差异均无统计学意义(P>0.05)。结论 治疗高血压性基底节区脑出血患者经额穿刺联合神经内镜经额叶清除术及显微镜经侧裂清除术均为有效的治疗手段,前者在清除血肿、减少术中出血、缩短手术及住院时间、降低并发症发生率、促进预后等方面略有优势。Objective To investigate the clinical effect of hematoma evacuation via transfrontal puncture combined with neuroendoscopy and via lateral fissure in the treatment of hypertensive intracerebral hemorrhage.Methods A total of 70 patients with cerebral hemorrhage in the basal ganglia region treated in Hecchuan District People′s Hospital of Chongqing from June 2022 to December 2023 were retrospectively selected,and divided into microsurgery group and endoscopic group,according to different surgical methods,with 35 cases in each group.The microsurgery group patients received hematoma evacuation via lateral fissure with microscope.The endoscopic group patients received hematoma evacuation via transfrontal puncture combined with neuroendoscopy.The intraoperative situation,complications and prognosis of the two groups were evaluated and compared.Results The intraoperative blood loss,operation time,postoperative hospital stay and complication rate in endoscopic treatment group were significantly lower than those in microsurgery group,and the clearance rate of hematoma was significantly higher than that in microsurgery group,with statistical significance(P<0.05).There was no significant difference in intracranial pressure between 2 groups before surgery and 1 and 5 days after surgery(P>0.05).The intracranial pressure in 2 groups was significantly lower than that before operation on day 1 and 5 after surgery,and the differences were statistically significant(P<0.05).Compared with the preoperative results,the Glasgow coma score and Barthel index score of the 2 groups were significantly increased 14 days after surgery,and the score of the National Institutes of Health Stroke scale was significantly decreased 30 days after surgery,and the increase or decrease of patients in the endoscopic treatment group was more obvious than that in the microsurgery group at each time point.The differences were statistically significant(P<0.05).The incidence of complications in endoscopic treatment group was significantly lower than that in

关 键 词：经额叶穿刺术 神经内镜手术 显微镜经侧裂清除术 基底节区脑出血 

分 类 号：R743.34[医药卫生—神经病学与精神病学]