神经内镜锁孔入路与传统开颅术治疗颅内血肿的对比研究

目的研究评价神经内镜锁孔入路清除颅内血肿的临床疗效及安全性。方法回顾性分析21例颅内出血患者采用神经内镜治疗的临床资料,另随机选择同期30例采用传统开颅显微镜下血肿清除术治疗颅内血肿患者作为对照组。以病死率、血肿量,血肿清除率、感染率、GCS评分、mRS评分、GOS评分等作为疗效指标。结果神经内镜组血肿清除率明显高于传统手术治疗组,两组差异具有明显统计学意义,且神经内镜组术后感染率低于对照组。两组在病死率、GOS评分、出院时GCS评分、6个月mRS评分方面差异均无统计学意义。而神经内镜组患者术后恢复良好率(GOS≥4)明显高于对照组,差异具有统计学意义。结论神经内镜经锁孔入路治疗颅内血肿临床疗效满意,具有较高的血肿清除率,明显降低术后感染发生率,显著提高患者术后的神经功能恢复。

A comparative study of neuroendoscopic surgery via keyhole versus craniotomy approach for intracerebral hemorrhages

Objective To evaluate the clinical effects of the neuroendoscopic approach without sheath in the treatment of intracerebral hemorrhage （ICH）. Methods The clinical data of 21 patients of ICH by neuroendoscopic therapy were analyzed retrospectively, and 30 patients of ICH treated with craniotomy were used as a control group. The clinical and radiographical outcomes included the mortality rate, hematoma volume, hematoma evacuation rates, infection rates, Glasgow Coma Scale （GCS） scores on admission, the third postoperative day, and at discharge, Modified Rankin Scale （mRS） on admission, at discharge, and during follow-up examinations conducted at 6 months post- surgery, and Glasgow Outcome Scale （GOS） scores at discharge and follow-up examinations. Results The hematoma evacuation rate was significantly higher in the neuroendoscopy group compared to the craniotomy group,and the rate of infection was lower in the neuroendoscopy group compared to the craniotomy. Mortality rates between the 2 groups did not show statistically significant differences. There were no statistically significant differences in the GOS and mRS scores at 6 months post-treatment or in the GCS scores at discharge between the two intervention groups. Patients in the Extraendoscopic neurosurgery group had better outcomes（ GOS 4 and 5） than patients in the control group. Conclusion The neuroendoscopic approach without sheath as a treatment for intracranial hematomas shows higher rate of hematoma evacuation and lower rate of infection.