立体定向引导神经内镜与经侧裂入路显微镜下血肿清除术治疗HICH患者的疗效比较  

Comparison of the Therapeutic Effects between Stereotactic Guided Neuroendoscopy and Lateral Fissure Approach Hematoma Evacuation in the Treatment of HICH Patients

作　　者：王成林 颜长春 苏杭州 WANG Cheng-lin;YAN Chang-chun;SU Hang-zhou(Department of Neurosurgery,Anhai Hospital of Jinjiang(Jinjiang Second Hospital),Jinjiang,Fujian,362261,China)

机构地区：[1]晋江市安海医院(晋江市第二医院)神经外科,福建晋江362261

出　　处：《现代生物医学进展》2025年第7期1191-1198,共8页Progress in Modern Biomedicine

基　　金：泉州市科技局项目(2024NY010)。

摘　　要：目的:比较立体定向引导神经内镜和经侧裂入路显微镜下血肿清除术治疗高血压脑出血(HICH)患者的疗效。方法:选择我院2022年3月至2024年2月期间收治的92例HICH患者,根据手术方法分为对照组(45例,经侧裂入路显微镜下血肿清除术治疗)和研究组(47例,立体定向引导神经内镜下血肿清除术治疗)。对比两组格拉斯哥昏迷量表(GCS)评分、日常生活活动能力量表(ADL)、围术期指标、美国国立卫生研究院脑卒中量表(NIHSS)、神经营养因子水平[神经元特异性烯醇化酶(NSE)、髓鞘碱性蛋白(MBP)、脑源性神经营养因子(BDNF)]、格拉斯哥预后评分(GOS)。结果:与对照组相比,研究组术中出血量更少,住院时间、手术用时更短,血肿清除率更高(P<0.05)。两组术后7天GCS评分增加,且研究组高于对照组(P<0.05)。两组术后7天BDNF升高,且研究组高于对照组;NSE、MBP下降,且研究组低于对照组(P<0.05)。两组术后3个月ADL评分升高,且研究组高于对照组;NIHSS评分下降,且研究组低于对照组(P <0.05)。研究组术后3个月预后良好比例高于对照组(P<0.05)。结论:相较于经侧裂入路显微镜下血肿清除术,立体定向引导神经内镜下血肿清除术治疗HICH,可进一步改善患者临床症状、围术期指标、神经营养因子水平、预后情况,并可减轻患者神经功能缺损,提高患者日常生活活动能力。Objective:To compare the efficacy of stereotactic guided neuroendoscopy and microscopic hematoma removal through lateral fissure approach in the treatment of hypertensive intracerebral hemorrhage( HICH) patients.Methods:92 patients with HICH who were admitted to our hospital from March 2022 to February 2024 were selected,they were divided into control group( 45cases,treated with lateral fissure approach hematoma evacuation) and study group( 47 cases,stereotactic guided neuroendoscopy hematoma evacuation) according to surgical methods.The glasgow coma scale( GCS) scores,activities of daily living( ADL),perioperative indicators,national institutes of health stroke scale( NIHSS),neurotrophic factor levels [ neuron specific enolase( NSE),myelin basic protein( MBP),brain derived neurotrophic factor( BDNF) ],and glasgow outcome scale( GOS) between two groups were compared.Results:Compared with control group,the study group had less intraoperative bleeding,shorter hospital stay and surgical time,and higher hematoma clearance rate( P<0.05).The GCS scores of both groups increased 7 d after surgery,and the study group was higher than that of the control group( P<0.05).BDNF levels increased in both groups 7 d after surgery,and the study group was higher than that of the control group,NSE and MBP decreased,and the study group was lower than that of the control group( P<0.05).The ADL scores of both groups increased 3 months after surgery,and the study group was higher than that of the control group,the NIHSS score decreased and the study group was lower than that of the control group( P<0.05).The proportion of patients with good prognosis 3 months after surgery of the study group was higher than that of the control group( P<0.05).Conclusion:Compared with lateral fissure approach,stereotactic guided neuroendoscopy hematoma evacuation can further improve clinical symptoms,perioperative indicators,neurotrophic factor levels,prognosis,and alleviate neurological deficits in patients with HICH,and it can also improve patients' dail

关 键 词：立体定向 神经内镜 经侧裂入路显微镜下血肿清除术 高血压脑出血 疗效 

分 类 号：R3[医药卫生—基础医学] R651.1R743.34