幕上高血压脑出血不同手术方式的疗效对比分析

目的 探讨神经内镜微创手术与常规骨瓣开颅血肿清除术、血肿穿刺引流术治疗高血压脑出血疗效的区别。 方法 收集经手术治疗的幕上高血压脑出血患者90例,分为常规骨瓣开颅手术组(开颅组)、血肿穿刺引流组(穿刺组)和神经内镜手术组(内镜组),每组30例。通过手术时间、血肿清除率、术后格拉斯哥评分(GCS)、住院时间、术后并发症和术后6月改良Rankin量表(mRS)进行评分,比较3组患者的手术疗效。 结果 90例患者均接受持续随访,随访时间>6月。内镜组、穿刺组及开颅组的手术时间分别为(1.5±0.4),(0.79±0.2)及(3.75±0.61)h,3组间比较,差别有统计学意义(P<0.05); 3组的术后第1天血肿清除率分别为(87.34%±3.42%),(52.81%±6.67%)及(86.62%±4.45%),3组间比较,差别有统计学意义(P<0.05); 3组的术后第7天GCS评分分别为(2.90±1.45),(13.07±1.80)及(11.73±2.48),3组间比较,差别有统计学意义(P<0.05); 入院时血肿量>60 mL患者的6月改良mRS评分,3组分别为(4.25±0.95),(3.25±0.50)及(2.67±0.71),3组间比较,差别有统计学意义(P<0.05); 入院时GCS评分为5～8分的患者的6月改良mRS评分,3组分别为(4.50±0.54),(3.00±0.53)及(2.80±0.78),3组间比较,差别有统计学意义(P<0.05)。 结论 对于幕上高血压脑出血患者,特别是血肿量>60 mL或GCS评分为5～8的患者,神经内镜治疗相较于其他两种外科手术,可更安全、有效地清除血肿,神经功能的改善也更大。

Comparative Analysis of the Curative Effect of Different Surgical Methods for Supratentorial Hypertensive Intracerebral Hemorrhage

Objective To investigated the value of endoscopic evacuation, stereotactic aspiration, and craniotomy of the hypertensive intracerebral hemorrhage and to determine which methods are more suitable for the patients. Methods 90 patients with supratentorial hypertensive intracerebral hemorrhage treated by surgery were enrolled and divided into craniotomy group, hematoma puncture drainage group, or neuroendoscopic surgery group, 30 patients in each group. The characteristics of all the enrolled patients at the time of admission were assimilated. Also, the therapeutic effects of the three surgical procedures were evaluated based on short-term outcomes within 30 days and long-term outcomes at 6 months after the ictus. Results All 90 patients were followed up for more than 6 months continuously. There was no significant difference in preoperative clinical data among the 3 groups(P>0.05). The operation time was(1.5±0.4)h in the endoscopic group,(0.79±0.2)h in the stereotactic aspiration group, and(3.75±0.61)h in the craniotomy group. The differences among the 3 groups were statistically significant(P<0.05). The evacuation rate of hematoma on day 1 postoperation in stereotactic aspiration group(52.81%±6.67%)was significantly less than the other 2 groups(endoscopic group: 87.34%±3.42%; craniotomy: 86.62%±4.45%, P<0.005). GCS scores on day 7 after surgery: craniotomy group(11.73±2.48), stereotactic aspiration group(13.07±1.80), endoscopic group(2.90±1.45), a significant difference was observed among 3 groups(P<0.05). For patients with large hematoma(>60 mL)or poor consciousness(GCS score 5-8), endoscopic group exhibited the lowest mRS score among the 3 groups, with statistically significant differences(P<0.05). Conclusions The endoscopic surgery may be safer and more effective with higher evacuation rate, better functional neurological outcomes, lower complication, and mortality rates. Severely affected patients with hematoma volume>60 mL or Glasgow Coma Scale score 5-8 may benefit more from endoscopic surgery than the two other surgical procedures.