高血压性脑叶出血微创外科治疗的随机对照试验研究

目的 比较3种微创手术治疗高血压性脑叶出血的疗效。方法 根据术前不同的血肿量,将120例高血压性脑叶出血患者分为大血肿组和小血肿组,每组60例。根据随机信封法,每组分为小骨窗组（采用神经导航辅助小骨窗开颅血肿清除术）、钻孔组（采用神经导航下血肿腔置管钻孔引流术）和内镜组（采用神经导航辅助神经内镜下血肿清除术）,每组20例。比较各组患者的基本资料;术中资料：手术时间、术中失血量;术后资料：术后6 h、3 d、7 d血肿清除率、格拉斯哥昏迷指数评分（GCS）,术后并发症（气管切开、颅内感染、再出血）,引流管留置时间及注药时间;预后资料：术后3个月格拉斯哥预后评分（GOS）。结果 大血肿组和小血肿组中各手术组的年龄、术前血肿量、出血位置、发病到手术时间以及术前GCS评分差异无统计学意义（P>0.05）。大血肿组和小血肿组中,与小骨窗组和内镜组比较,钻孔组的手术时间最短,术中失血量最少,术后6 h、3 d的血肿清除率降低,引流管留置时间延长（P<0.05）,3组并发症比较差异无统计学意义。大血肿组中,内镜组术后6 h的GCS评分高于钻孔组,术后3 d、7 d的GCS评分高于小骨窗组与钻孔组（P<0.05）。大血肿组中钻孔组平均注药时间长于小血肿组（P<0.05）。大血肿组中内镜组的预后优率高于小骨窗组和钻孔组（P<0.05）,而小血肿组中3组预后优率比较差异无统计学意义（P>0.05）。结论 血肿腔置管钻孔引流术能缩短手术时间,减少术中失血量;而神经内镜下血肿清除术和小骨窗开颅血肿清除术均有较高的血肿清除率。

A randomized controlled trial of minimally invasive surgery for hypertensive lobar hemorrhage

Objective To compare the therapeutic efficacy of three types of minimally invasive procedures on hypertensive lobar hemorrhage. Methods According to the different preoperative hematoma volume, 120 patients with hypertensive lobar hemorrhage were divided into the large hematoma group and the small hematoma group, with 60 patients in each group. According to the random envelope method, each group was subdivided into the small bone window group (small bone window craniotomy assisted by neuronavigation for hematoma removal), the drilling group (hematoma cavity drainage assisted by neuronavigation) and the endoscopic group (neuroendoscopic hematoma removal assisted by neuronavigation), with 20 patients in each group. The following data of patients in each group were compared, including basic data, intraoperative data (operation time, intraoperative blood loss), postoperative data, hematoma clearance rates at 6 h, 3 d and 7 d after operation, Glasgow coma index score (GCS) at 6 h, 3 d and 7 d after operation, postoperative complications (tracheotomy, intracranial infection, recurrent bleeding), drainage tube retention time and drug injection time, prognosis data, Glasgow prognosis score (GOS) at 3 months after operation. Results There were no significant differences in age, preoperative hematoma volume, bleeding location, onset to operation time and preoperative GCS score between the large hematoma group and the small hematoma group (P>0.05). In the large hematoma group and the small hematoma group, compared with the small bone window group and the endoscopic group, the drilling group had the shortest operation time, the least intraoperative blood loss, and the hematoma clearance rate was reduced at 6 h and 3 d after surgery, and the drainage tube retention time was prolonged (P<0.05). There were no significant differences in complications between the three groups. In the large hematoma group, the GCS score was higher at 6 h after surgery in the endoscopic group than that of the drilling group, and the GCS score was higher at 3 d and 7 d after surgery in the endoscopic group than that of the small bone window group and the drilling group (P<0.05). In the large hematoma group, the average injection time was longer in the drilling group than that of the small hematoma group (P<0.05). In the large hematoma group, the favorable prognostic rate was higher in the endoscopic group than that of the small bone window group and the drilling group (P<0.05), while there was no significant difference in the favorable prognostic rate between the three subgroups of the small hematoma group (P>0.05). Conclusion Hematoma cavity catheterization and drainage can shorten the operation time and reduce the intraoperative blood loss. Both neuroendoscopy and small bone window craniotomy have higher hematoma clearance rates.