神经内镜微创术与微创钻孔引流术治疗高血压脑出血的临床效果与安全性分析
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摘要
目的对比分析神经内镜微创手术与微创钻孔引流术治疗高血压脑出血的临床效果与安全性。方法收集2017年1月-2017年12月该院神经外科收治的90例高血压脑出血患者的病历资料,进行回顾性分析。根据手术方式不同分为A组(47例,行神经内镜微创手术)和B组(43例,行微创钻孔引流手术),比较两组患者的手术时间、术中出血量、血肿清除率、住院时间、术后并发症发生情况及预后情况。结果 B组手术时间和术中出血量明显少于A组,A组血肿清除率(92.84±4.73)%明显高于B组(87.52±5.39)%,差异具有统计学意义(P <0.05)。两组术后住院时间、再出血发生率、并发症发生率和死亡率比较,差异均无统计学意义(P>0.05)。术后3个月与术前比较,两组的美国国立卫生研究院脑卒中评分量表(NIHSS)均明显降低,日常生活活动评分(ADL)均明显升高,两组比较,差异均无统计学意义(P>0.05)。A组和B组术后6个月预后良好率分别为93.62%和83.72%,组间比较差异无统计学意义(P>0.05)。结论神经内镜微创术可提高血肿清除效果,微创钻孔引流术可缩短手术时间,减少术中出血量,两者均安全、可靠,且预后较好。
Objective To compare and analyze the clinical efficacy and safety between endoscopic minimally invasive surgery and minimally invasive drainage for hypertensive cerebral hemorrhage. Methods The clinical data of 90 cases patients with hypertensive cerebral hemorrhage from January 2017 to December 2017 were collected and retrospectively analyzed. According to the different surgical methods, all the 90 cases patients were divided into A group(47 cases, underwent endoscopic minimally invasive surgery) and B group(43 cases, underwent minimally invasive drainage). The operation time, bleeding volume, clearance of hematoma, hospital stay, postoperative complication and prognosis conditions were compared between the two groups. Results The operation time in the B group was significantly shorter than that in the A group, and the bleeding volume in the B group was significantly less than that in the A group, and the clearance of hematoma in the A group(92.84 ± 4.73)% was significantly higher than that in the B group(87.52 ± 5.39)%, all above had statistical difference(P < 0.05). There was no statistical difference in the hospital stay, recurrence rate, complication rate and mortality rate between two groups(P > 0.05).At 3 months after operation, the NIHSS scores were significantly decreased and the ADL scores were significantly increased before operation, all above had statistical difference(P < 0.05), there was no significant difference between the two groups(P > 0.05) while there was no statistical difference in the NIHSS and ADL scores between the two groups(P > 0.05). Conclusion The endoscopic minimally invasive surgery could improve the removal of hematoma,and the minimally invasive drainage could shorten operative time and reduce intraoperative blood loss. Both the two methods are safe, reliable and have good prognosis.
Objective To compare and analyze the clinical efficacy and safety between endoscopic minimally invasive surgery and minimally invasive drainage for hypertensive cerebral hemorrhage. Methods The clinical data of 90 cases patients with hypertensive cerebral hemorrhage from January 2017 to December 2017 were collected and retrospectively analyzed. According to the different surgical methods, all the 90 cases patients were divided into A group(47 cases, underwent endoscopic minimally invasive surgery) and B group(43 cases, underwent minimally invasive drainage). The operation time, bleeding volume, clearance of hematoma, hospital stay, postoperative complication and prognosis conditions were compared between the two groups. Results The operation time in the B group was significantly shorter than that in the A group, and the bleeding volume in the B group was significantly less than that in the A group, and the clearance of hematoma in the A group(92.84 ± 4.73)% was significantly higher than that in the B group(87.52 ± 5.39)%, all above had statistical difference(P < 0.05). There was no statistical difference in the hospital stay, recurrence rate, complication rate and mortality rate between two groups(P > 0.05).At 3 months after operation, the NIHSS scores were significantly decreased and the ADL scores were significantly increased before operation, all above had statistical difference(P < 0.05), there was no significant difference between the two groups(P > 0.05) while there was no statistical difference in the NIHSS and ADL scores between the two groups(P > 0.05). Conclusion The endoscopic minimally invasive surgery could improve the removal of hematoma,and the minimally invasive drainage could shorten operative time and reduce intraoperative blood loss. Both the two methods are safe, reliable and have good prognosis.
引文
[1]范广明,张文,毛振立.神经内镜微创手术与小骨窗开颅显微手术治疗幕上高血压脑出血的临床效果[J].解放军医药杂志,2017,29(1):90-93.[1]FAN G M,ZHANG W,MAO Z L.Clinical effect of endoscopic minimally invasive surgery and small bone window craniotomy microsurgery in treatment of supratentorial hypertensive intracerebral hemorrhage[J].Medical&Pharmaceutical Journal of Chinese People’s Liberation Army,2017,29(1):90-93.Chinese
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[3]叶富跃,杨堃,郑传宜,等.颅内微创血肿清除术与传统开颅清除血肿手术在高血压脑出血中的应用效果分析[J].河北医学,2016,22(1):17-20.[3]YE F Y,YANG K,ZHENG C Y,et al.Analysis on the effect of minimally invasive intracranial hematoma removal surgery with the traditional craniotomy hematoma in hypertensive cerebral hemorrhage[J].Hebei Medicine,2016,22(1):17-20.Chinese
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[6]美国国立卫生研究院.美国国立卫生研究院脑卒中量表(NIHSS)简介[J].临床荟萃,2009,24(8):685.[6]National Institutes of Health.Brief introduction of the national institute of health stroke scale(NIHSS)[J].Clinical Focus,2009,24(8):685.Chinese
[7]成杰,董立焕,刘艳丰,等.Brunel平稳评定表信效度与患者日常生活活动能力和行走功能相关性研究[J].重庆医学,2017,46(17):2353-2355.[7]CHENG J,DONG L H,LIU Y F,et al.Correlation between reliability and validity of Brunel balance assessment with activities of daily living[J].Chongqing Medicine,2017,46(17):2353-2355.Chinese
[8]沈健,杨华.不同手术时机小骨窗显微手术治疗高血压脑出血与日常生活活动能力量表、格拉斯哥预后评分的相关性[J].中国老年学杂志,2017,37(2):354-355.[8]SHEN J,YANG H.The correlation of microsurgical treatment for hypertensive intracerebral hemorrhage by small bone window at different operative time and the activity of daily life scale and Glasgow prognosis score[J].Chinese Journal of Gerontology,2017,37(2):354-355.Chinese
[9]段吉强,姚胜,王阳,等.不同手术时机治疗高血压脑出血的临床效果对比[J].中国医药导报,2018,15(2):71-74.[9]DUAN J Q,YAO S,WANG Y,et al.Comparison on the clinical effect of treatment for hypertensive cerebral hemorrhage at different operation opportunities[J].China Medical Herald,2018,15(2):71-74.Chinese
[10]GAO Z,QIAN L,NIU C,et al.Evacuating hypertensive intracerebral hematoma with a cortical sulcus approach[J].World Neurosurg,2016,95:341-347.
[11]赵明明,赵阳阳,莫小樱,等.高血压性脑出血病理生理研究进展[J].中国卫生标准管理,2018,9(6):106-108.[11]ZHAO M M,ZHAO Y Y,MO X Y,et al.Progress in pathophysiology of hypertensive cerebral hemorrhage[J].China Health Standard Management,2018,9(6):106-108.Chinese
[12]LIANG K S,DING J,YIN C B,et al.Clinical study on minimally invasive liquefaction and drainage of intracerebral hematoma in the treatment of hypertensive putamen hemorrhage[J].Technol Health Care,2017,25(6):1061-1071.
[13]ZHAO J,MAO Q,QIAN Z,et al.Effect of mild hypothermia on expression of inflammatory factors in surrounding tissue after minimally invasive hematoma evacuation in the treatment of hypertensive intracerebral hemorrhage[J].Exp Ther Med,2018,15(6):4906-4910.
[14]李春虎,郑全乐,张家瑞,等.微创钻孔引流术在高血压脑出血中的应用价值研究[J].中华神经创伤外科电子杂志,2017,3(2):80-84.[14]LI C H,ZHENG Q L,ZHANG J R,et al.Application value of minimally invasive drainage in hypertensive cerebral hemorrhage[J].Chinese Journal of Neurotraumatic Surgery:Electronic Edition,2017,3(2):80-84.Chinese
[15]滕楚北,屈洪涛.三种不同手术方法在高血压性脑出血患者中的应用与比较[J].中国现代医药杂志,2017,19(11):48-51.[15]TENG C B,QU H T.Application and comparison of three different surgical methods in patients with hypertensive cerebral hemorrhage[J].Modern Medicine Journal of China,2017,19(11):48-51.Chinese
[16]吴旺春,陈水钰,彭演国,等.开颅血肿清除术与微创钻孔引流术治疗高血压脑出血的临床疗效对比[J].中外医疗,2018,37(7):73-75.[16]WU W C,CHEN S Y,PENG Y G,et al.Comparison of the clinical efficacy of craniotomy hematoma removal and minimally invasive drilling and drainage in the treatment of hypertensive intracerebral hemorrhage[J].China&Foreign Medical Treatment,2018,37(7):73-75.Chinese
[17]程晓颖,张宗平,叶锋,等.神经内镜微创术和开颅去骨瓣血肿清除术治疗高血压性小脑出血的疗效比较[J].齐齐哈尔医学院学报,2015,36(6):807-808.[17]CHENG X Y,ZHANG Z P,YE F,et al.Efficacy comparison of neuroendoscopy and craniotomy for removal of hematoma in the treatment of hypertensive cerebellar hemorrhage[J].Journal of Qiqihar Medical University,2015,36(6):807-808.Chinese
[18]林爱国,刘小波,何程,等.微创钻孔引流与开颅血肿清除术治疗中老年高血压脑出血的临床疗效及预后比较[J].医药前沿,2018,4(7):51-52.[18]LIN A G,LIU X B,HE C,et al.Clinical efficacy of minimally invasive drilling drainage and craniotomy for removal of hematoma in treatment of hypertension compared in middle-age patients and it’s prognosis[J].Journal of Frontiers of Medicine,2018,4(7):51-52.Chinese
[2]ALTINTAS O,DURUYEN H,BARAN G,et al.The relationship of hematoma growth to red blood cell distribution width in patients with hypertensive intracerebral hemorrhage[J].Turk Neurosurg,2017,27(3):368-373.
[3]叶富跃,杨堃,郑传宜,等.颅内微创血肿清除术与传统开颅清除血肿手术在高血压脑出血中的应用效果分析[J].河北医学,2016,22(1):17-20.[3]YE F Y,YANG K,ZHENG C Y,et al.Analysis on the effect of minimally invasive intracranial hematoma removal surgery with the traditional craniotomy hematoma in hypertensive cerebral hemorrhage[J].Hebei Medicine,2016,22(1):17-20.Chinese
[4]MOUSSA W M,KHEDR W.Decompressive craniectomy and expansive duraplasty with evacuation of hypertensive intracerebral hematoma,a randomized controlled trial[J].Neurosurg Rev,2017,40(1):115-127.
[5]中华医学会神经病学分会.中国脑出血诊治指南(2014)[J].中华神经科杂志,2015,48(6):435-444.[5]Chinese Society of Neurology.Guidelines for the diagnosis and treatment of cerebral hemorrhage in China(2014)[J].Chinese Journal of Neurology,2015,48(6):435-444.Chinese
[6]美国国立卫生研究院.美国国立卫生研究院脑卒中量表(NIHSS)简介[J].临床荟萃,2009,24(8):685.[6]National Institutes of Health.Brief introduction of the national institute of health stroke scale(NIHSS)[J].Clinical Focus,2009,24(8):685.Chinese
[7]成杰,董立焕,刘艳丰,等.Brunel平稳评定表信效度与患者日常生活活动能力和行走功能相关性研究[J].重庆医学,2017,46(17):2353-2355.[7]CHENG J,DONG L H,LIU Y F,et al.Correlation between reliability and validity of Brunel balance assessment with activities of daily living[J].Chongqing Medicine,2017,46(17):2353-2355.Chinese
[8]沈健,杨华.不同手术时机小骨窗显微手术治疗高血压脑出血与日常生活活动能力量表、格拉斯哥预后评分的相关性[J].中国老年学杂志,2017,37(2):354-355.[8]SHEN J,YANG H.The correlation of microsurgical treatment for hypertensive intracerebral hemorrhage by small bone window at different operative time and the activity of daily life scale and Glasgow prognosis score[J].Chinese Journal of Gerontology,2017,37(2):354-355.Chinese
[9]段吉强,姚胜,王阳,等.不同手术时机治疗高血压脑出血的临床效果对比[J].中国医药导报,2018,15(2):71-74.[9]DUAN J Q,YAO S,WANG Y,et al.Comparison on the clinical effect of treatment for hypertensive cerebral hemorrhage at different operation opportunities[J].China Medical Herald,2018,15(2):71-74.Chinese
[10]GAO Z,QIAN L,NIU C,et al.Evacuating hypertensive intracerebral hematoma with a cortical sulcus approach[J].World Neurosurg,2016,95:341-347.
[11]赵明明,赵阳阳,莫小樱,等.高血压性脑出血病理生理研究进展[J].中国卫生标准管理,2018,9(6):106-108.[11]ZHAO M M,ZHAO Y Y,MO X Y,et al.Progress in pathophysiology of hypertensive cerebral hemorrhage[J].China Health Standard Management,2018,9(6):106-108.Chinese
[12]LIANG K S,DING J,YIN C B,et al.Clinical study on minimally invasive liquefaction and drainage of intracerebral hematoma in the treatment of hypertensive putamen hemorrhage[J].Technol Health Care,2017,25(6):1061-1071.
[13]ZHAO J,MAO Q,QIAN Z,et al.Effect of mild hypothermia on expression of inflammatory factors in surrounding tissue after minimally invasive hematoma evacuation in the treatment of hypertensive intracerebral hemorrhage[J].Exp Ther Med,2018,15(6):4906-4910.
[14]李春虎,郑全乐,张家瑞,等.微创钻孔引流术在高血压脑出血中的应用价值研究[J].中华神经创伤外科电子杂志,2017,3(2):80-84.[14]LI C H,ZHENG Q L,ZHANG J R,et al.Application value of minimally invasive drainage in hypertensive cerebral hemorrhage[J].Chinese Journal of Neurotraumatic Surgery:Electronic Edition,2017,3(2):80-84.Chinese
[15]滕楚北,屈洪涛.三种不同手术方法在高血压性脑出血患者中的应用与比较[J].中国现代医药杂志,2017,19(11):48-51.[15]TENG C B,QU H T.Application and comparison of three different surgical methods in patients with hypertensive cerebral hemorrhage[J].Modern Medicine Journal of China,2017,19(11):48-51.Chinese
[16]吴旺春,陈水钰,彭演国,等.开颅血肿清除术与微创钻孔引流术治疗高血压脑出血的临床疗效对比[J].中外医疗,2018,37(7):73-75.[16]WU W C,CHEN S Y,PENG Y G,et al.Comparison of the clinical efficacy of craniotomy hematoma removal and minimally invasive drilling and drainage in the treatment of hypertensive intracerebral hemorrhage[J].China&Foreign Medical Treatment,2018,37(7):73-75.Chinese
[17]程晓颖,张宗平,叶锋,等.神经内镜微创术和开颅去骨瓣血肿清除术治疗高血压性小脑出血的疗效比较[J].齐齐哈尔医学院学报,2015,36(6):807-808.[17]CHENG X Y,ZHANG Z P,YE F,et al.Efficacy comparison of neuroendoscopy and craniotomy for removal of hematoma in the treatment of hypertensive cerebellar hemorrhage[J].Journal of Qiqihar Medical University,2015,36(6):807-808.Chinese
[18]林爱国,刘小波,何程,等.微创钻孔引流与开颅血肿清除术治疗中老年高血压脑出血的临床疗效及预后比较[J].医药前沿,2018,4(7):51-52.[18]LIN A G,LIU X B,HE C,et al.Clinical efficacy of minimally invasive drilling drainage and craniotomy for removal of hematoma in treatment of hypertension compared in middle-age patients and it’s prognosis[J].Journal of Frontiers of Medicine,2018,4(7):51-52.Chinese