Hypertensive intracranial hematomas: endoscopic-assisted keyhole evacuation and application of patent viewing dissector  

作　　者：邱永明 林毅兴 田鑫 罗其中 

机构地区：[1]Department of Neurosurgery,Renji Hospital,Shanghai Second Medical University

出　　处：《Chinese Medical Journal》2003年第2期195-199,共5页中华医学杂志（英文版）

基　　金：ThisprojectwassupportedbytheShanghaiEducationDevelopmentFoundation (No 2 000B08)andpartiallysupportedbytheShanghaiHealthOrganization (No 98ZD0 0 3)

摘　　要：To study the effect of endoscopic assisted keyhole operation (EAKO) on treating hypertensive intracranial hematomas and the value of our patent dissector appli ed during the operation Methods A total of 25 patients with hypertensive intracranial hematomas underwent endos copic assisted keyhole evacuation, during which, the viewing dissector, which h ad recently achieved national patent, was connected to the tip of endoscope and used to help dissect hematomas The outcome of this procedure were compared wit h those of 22 comparable cases undergone conventional surgical treatment (large or smaller craniotomy) The items for comparison included the volum e of remaining hematoma, the duration of operation, postsurgical Glasgow Coma Sc ale (GCS) and Glasgow Outcome Scale (GOS) Results Remaining hematoma was ascertained 48 h after operation with the use of comp uterized tomography (CT) scans In the case of EAKO, nearly complete evacuation (>84%) was achieved in 21 cases; GCS was evaluated at 7 d postsurgery result ing in GCS >12 in 9 patients, GCS 9-12 in 12 patients and GCS <9 in 4 patients The follow up period ranged from 6 to 21 mon GOS was estimated at half a year and good recovery rate as defined by GOS was assigned to 76% of the EAKO pa tients There are significant differences in the volumes of remaining hematomas and the duration of operation between the EAKO and craniotomy group ( P <0 0 5) In addition, better clinical outcomes were obtained in EAKO Conclusion EAKO has the advantage of being minimally invasive, improving surgical results a nd the prognosis of hypertensive intracranial hematoma patients We conclude th at keyhole operation is a safe, effective alternative for removal of hypertensiv e intracranial hematoma, particularly during acute stagesTo study the effect of endoscopic assisted keyhole operation (EAKO) on treating hypertensive intracranial hematomas and the value of our patent dissector appli ed during the operation Methods A total of 25 patients with hypertensive intracranial hematomas underwent endos copic assisted keyhole evacuation, during which, the viewing dissector, which h ad recently achieved national patent, was connected to the tip of endoscope and used to help dissect hematomas The outcome of this procedure were compared wit h those of 22 comparable cases undergone conventional surgical treatment (large or smaller craniotomy) The items for comparison included the volum e of remaining hematoma, the duration of operation, postsurgical Glasgow Coma Sc ale (GCS) and Glasgow Outcome Scale (GOS) Results Remaining hematoma was ascertained 48 h after operation with the use of comp uterized tomography (CT) scans In the case of EAKO, nearly complete evacuation (>84%) was achieved in 21 cases; GCS was evaluated at 7 d postsurgery result ing in GCS >12 in 9 patients, GCS 9-12 in 12 patients and GCS <9 in 4 patients The follow up period ranged from 6 to 21 mon GOS was estimated at half a year and good recovery rate as defined by GOS was assigned to 76% of the EAKO pa tients There are significant differences in the volumes of remaining hematomas and the duration of operation between the EAKO and craniotomy group ( P <0 0 5) In addition, better clinical outcomes were obtained in EAKO Conclusion EAKO has the advantage of being minimally invasive, improving surgical results a nd the prognosis of hypertensive intracranial hematoma patients We conclude th at keyhole operation is a safe, effective alternative for removal of hypertensiv e intracranial hematoma, particularly during acute stages

关 键 词：NEUROENDOSCOPE dissector keyhole operatio n hypertensive intracranial hematoma 

分 类 号：R651.15[医药卫生—外科学] TH782[医药卫生—临床医学]