基底节区高血压脑出血不同微创手术方式的比较

目的 比较三种微创手术方式治疗基底节区高血压脑出血的临床疗效及预后情况.方法 选择GCS在6～12分,原发出血部位均为基底节的高血压脑出血患者78例,分为三组,分别采取神经内镜下血肿清除(神经内镜组)、小骨窗开颅显微手术(小骨窗开颅组)、立体定向血肿碎吸术(立体定向组)三种手术方式;比较三组手术时间和术中失血量;术后2 d内复查CT,计算残余血肿量和血肿清除率;术后6个月按GOS预后评分评估治疗效果.结果 手术时间以小骨窗开颅组最长,达(175.7±55.7)min(P<0.05);术中失血量以小骨窗开颅组较其他两组显著增多(P<0.05),达(296.5±158.6)mL;血肿清除率以神经内镜组最高,达84.5%±8.2%(P<0.05);GOS预后比较中神经内镜组的疗效显著高于立体定向组和小骨窗开颅组(P<0.05).结论 神经内镜辅助下血肿清除术既有创伤小,又有血肿清除彻底、止血可靠的优点,疗效确切,对不需行去大骨瓣减压的脑出血患者是一种较理想的微创手术方式.

Comparison of different minimally invasive surgical methods for hypertensive hemorrhage in basal ganglia

Objective To compare the therapeutic efficacy, safety and complication incidence of three minimally invasive surgical procedures for hypertensive hemorrhage in basal ganglia. Methods According to the operation procedure, 78 patients with basal ganglia hemorrhage (GCS 6-12) were divided into endoscopic surgery group, stereotactic burr-hole aspiration group and small bone flap craniotomy group. The time of operation, and the blood loss volume during operation were compared among the 3 groups. CT was reused to calculate the residual volume and clearance rate of hematoma within 2 d after operation. The neurological outcomes, case fatality rate were analyzed after 6 months of the surgery according to the Glasgow Outcome Scale (GOS). Results The small bone flap craniotomy group had the longest operation time (175.7±55.7) min, P＜0.05]. The blood loss volume (296.5±158.6)mL] during operation in small bone flap craniotomy group was relatively more than those in the other 2 groups (P＜0.05). The endoscopic surgery group had the highest hematoma clearance rate (84.5%±8.2%,P＜0.05). The therapeutic outcomes evaluated by GOS in the endoscopic surgery group were more satisfactory than those in the other 2 groups (P＜0.05). Conclusions Endoscopic surgery not only leads to less tissue damage, but also has advantages of higher hematoma clearance rate and effective hemostasis resulting in better neurological functional outcomes, therefore is an ideal choice for cerebral hemorrhage patients who has no need of large bone flap craniotomy.