神经内镜在治疗老年人脑室出血中的临床应用

目的比较不同方法治疗老年人脑室出血的临床疗效。方法应用神经内镜治疗老年性脑室出血19例,以单纯侧脑室钻孔引流术治疗同类疾病25例为对照组,并相互比较。结果内镜组脑内或(和)脑室内血肿绝大部分清除者(90%以上)者16例,未发现继发出血,术后无颅内感染,术后6个月对患者进行ADL评分,Ⅰ级8例,Ⅱ级5例,Ⅲ级3例,Ⅳ1例,Ⅴ级1例,死亡1例。侧脑室钻孔组引流组仅有4例脑室内血肿大部分清除(60%以下),1例继发出血,术后颅内感染2例。术后6个月对患者进行ADL(glasgow outcome scale)评分比较,Ⅰ级4例,Ⅱ级7例,Ⅲ级4例,Ⅳ5例,Ⅴ级3例,死亡2例。与内镜组相比术后好转优良率低(P0.05),差异有统计学意义;死亡率差异无统计学意义(P0.05)。结论神经内镜治疗老年性脑室出血具有微创、直视、血肿清除及预后好的优点。

Surgical treatment under neuroendoscope for intraventricular hemorrhage in the elderly

Objective To compare the different surgicalways in order to evaluate the new way of minimally invasive treatment of ventricular hemorrhage in the elderly. Methods Neuroendoscopy was applied to treat19 cases of ventricular hemorrhage in the elderly. 25 cases that were treated by ventrieular drainage were taken as controls. Results In neuroendoscope group, nearly compete evacuation of intracerebral or/and intraventricularhematoma was achieved in 16 cases. There was not intracranial infection after surgery and secondary hemorrhage in all cases. ADL grades 6 months after operation were graded 8 cases of ADL Ⅰ grade, 5 cases of ADL Ⅱ grade, 3 cases of ADL Ⅲgrade, 1 cases of ADL Ⅳ grade, 1 case of ADL Ⅴ grade, 1 case of dead were found in endoscopy treatment group, In EVD （External ventricular drainage） group,partial evacuation of intracerebral or/and intraventricular hematoma was achieved in 4 cases, no One secondary hemorrhage,intracranial infection after surgery in 2 cases. ADL grades 6 months after operation.4 cases of ADL Ⅰ grade, 7 cases of ADL Ⅱ grade,4 cases of ADL Ⅲ grade, 5 cases of ADL Ⅳ grade, 3 case of ADL Ⅴ grade, 2 case of dead. More patients in the neuroendoscope group showed good recovery after twomonths （P〈0. 05）. The difference between the two groups inmortality rate was not statistically significant （P〉0. 05）. Conclusion Surgical treatment under neuroendoscope for intraventricular hemorrhage in the elderly is characterized by mini-invasion, and direct-vision,and effective hemorrhage evacuation and excellent postoperative outcomes.