神经内镜手术治疗自发性幕上中等程度脑出血的临床效果

doi:10.3877/cma.j.issn.2095-9141.2021.01.012

目的

比较神经内镜下微创手术与小骨窗开颅血肿清除术在治疗幕上中等程度脑出血患者中的疗效。

方法

回顾性分析高密市人民医院神经外科自2015年12月至2019年12月收治的90例自发性幕上中等程度脑出血患者的临床资料，采用随机数字表法将患者分为内镜组（45例）和骨窗组（45例），比较2组患者的手术情况、临床疗效及预后情况。

结果

内镜组手术完成时间短，术中出血量少，血肿清除率明显高于骨窗组，差异均有统计学意义（P<0.05）。内镜组术后并发症发生率明显低于骨窗组，术后第7天的GCS评分高于骨窗组为9分（P<0.05），2组术后再出血2例；术后6个月采用扩展格拉斯哥预后评分，内镜组预后良好率高于骨窗组，但差异无统计学意义（P>0.05）。

结论

神经内镜手术在脑出血患者治疗中安全可行，并且更加微创，能促进患者更早的康复。

关键词: 神经内镜, 微创手术, 幕上中等程度脑出血, 小骨窗开颅

Objective

To compare the efficacy of minimally invasive neurosurgery and small bone window craniotomy in the treatment of moderate supratentorial intracerebral hemorrhage.

Methods

Ninety patients with spontaneous supratentorial moderate intracerebral hemorrhage in Department of Neurosurgery of Gaomi People’s Hospital from December 2015 to December 2019 were retrospectively analyzed. The patients were randomly divided into endoscopic group (45 cases) and bone window group (45 cases). The surgical condition, clinical effect and prognosis of the two groups were analyzed and compared.

Results

The endoscopic group had shorter operation time, less blood loss and higher hematoma clearance rate than the bone window group (P<0.05). The incidence of postoperative complications in the endoscopic group was significantly lower than that in the bone window group, the GCS score on the 7^th day after operation was 9 points higher than that in the bone window group (P<0.05), and there were 2 cases of postoperative rebleeding in the two groups; the extended Glasgow prognosis score was used 6 months after operation, and the good prognosis rate in the endoscopic group was higher than that in the bone window group, but the difference was not statistically significant (P>0.05).

Conclusion

Our data indicate that endoscopic removal of moderate hematomas is safe, feasible and minimally invasive, and may promote earlier recovery in the treatment of hypertensive cerebral hemorrhage.

Key words: Neuroendoscopy, Minimally invasive surgery, Supratentorial moderate-volume hematoma, Small bone window craniotomy

表1 2组患者的一般资料比较

项目		内镜组(n=45)	骨窗组(n=45)	χ²/t值	P值
年龄（岁，±s）		55.43±10.91	54.28±12.13	0.232	0.817
性别（男/女）		33/12	30/15	0.476	0.490
血肿位置[例(%)]				0.278	0.598
	基底节区	35(78)	37(82)
	皮层下脑叶	10(22)	8(18)
出血量（mL，±s）		42.12±16.43	45.83±4.55	1.078	0.103
破入脑室[例(%)]				0.909	0.340
	是	10(22)	14(31)
	否	35(78)	31(69)
术前GCS评分(±s)		7.91±2.64	8.31±2.37	1.013	0.153
切口位置[例(%)]				42.787	0.000
	Kocher点	19(42)	0
	Keen点	10(22)	0
	血肿中心投影	16(36)	45(100)

表1 2组患者的一般资料比较

项目		内镜组(n=45)	骨窗组(n=45)	χ²/t值	P值
年龄（岁，±s）		55.43±10.91	54.28±12.13	0.232	0.817
性别（男/女）		33/12	30/15	0.476	0.490
血肿位置[例(%)]				0.278	0.598
	基底节区	35(78)	37(82)
	皮层下脑叶	10(22)	8(18)
出血量（mL，±s）		42.12±16.43	45.83±4.55	1.078	0.103
破入脑室[例(%)]				0.909	0.340
	是	10(22)	14(31)
	否	35(78)	31(69)
术前GCS评分(±s)		7.91±2.64	8.31±2.37	1.013	0.153
切口位置[例(%)]				42.787	0.000
	Kocher点	19(42)	0
	Keen点	10(22)	0
	血肿中心投影	16(36)	45(100)

表2 2组患者手术相关指标比较

指标	内镜组(n=45)	骨窗组(n=45)	t/χ²值	P值
平均血肿清除率（%，±s）	90.80±7.22	73.16±21.15	15.734	0.035
再出血率[例(%)]	1(2)	1(2)		0.753^a
术中出血量（mL，±s）	70.76±7.2	241.84±50.27	15.763	<0.001
手术时间（min，±s）	103±10.65	221±22.73	4.545	0.009
术后GCS评分（分，±s）	11.01±3.72	9.21±3.92	10.843	0.021
术后并发症[例(%)]	2(4)	9(20)	5.075	0.024

表2 2组患者手术相关指标比较

指标	内镜组(n=45)	骨窗组(n=45)	t/χ²值	P值
平均血肿清除率（%，±s）	90.80±7.22	73.16±21.15	15.734	0.035
再出血率[例(%)]	1(2)	1(2)		0.753^a
术中出血量（mL，±s）	70.76±7.2	241.84±50.27	15.763	<0.001
手术时间（min，±s）	103±10.65	221±22.73	4.545	0.009
术后GCS评分（分，±s）	11.01±3.72	9.21±3.92	10.843	0.021
术后并发症[例(%)]	2(4)	9(20)	5.075	0.024

图1 神经内镜下血肿清除术术前、术中和术后的影像学资料

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Effectiveness of endoscopic surgery for patients with moderate supratentorial intracerebral hemorrhages

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Effectiveness of endoscopic surgery for patients with moderate supratentorial intracerebral hemorrhages