内镜手术治疗高血压脑出血的手术技巧及疗效分析
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摘要
目的探讨神经内镜手术在高血压脑出血血肿清除中的疗效。方法收集我院神经外科2016年07月至2018年07月102例行高血压脑出血手术患者的临床资料,分为显微镜组及内镜组,其中显微镜下血肿清除52例(显微镜组),内镜下血肿清除50例(内镜组)。对两组患者手术相关指标(手术时间、手术出血量、血肿清除率)、并发症(颅内感染、脑梗塞)、术后6个月ADL评分进行比较分析。结果内镜组的手术时间、手术出血量均小于显微镜组(P<0.05),内镜组血肿清除率高于显微镜组(P<0.05),内镜组的颅内感染、脑梗塞与显微镜组无统计学差异(P>0.05),内镜组的术后6个月ADL评分优于显微镜组(P<0.05)。结论神经内镜下清除高血压脑出血具有直视视野广、止血确切、对正常脑组织及血管损伤小、预后好的特点,值得临床推广应用。
Objective To investigate the efficacy of neuroendoscopic surgery in the removal of hypertensive intracerebral hemorrhage hematoma. Methods 102 patients with hypertensive intracerebral hemorrhage underwent neurosurgery in our hospital from July 2016 to July 2018 were divided into microscopic group and endoscopic group. 52 patients underwent microscopic hematoma removal(microscopic group) and 50 patients underwent endoscopic hematoma removal(endoscopic group). The operation related indexes(operation time, bleeding volume, hematoma clearance rate), complications(intracranial infection, cerebral infarction) and ADL scores of 6 months after operation were compared and analyzed between the two groups. Results The operation time and bleeding volume of endoscopic group were less than those of microscopic group(P<0.05). The hematoma clearance rate of endoscopic group was higher than that of microscopic group(P<0.05). There was no significant difference between endoscopic group and microscopic group in intracranial infection, cerebral infarction(P>0.05). The ADL score of endoscopic group was better than that of microscopic group 6 months after operation(P<0.05). Conclusion Endoscopic clearance of hypertensive intracerebral hemorrhage has the characteristics of wide visual field, accurate hemostasis, less damage to normal brain tissues and blood vessels, and good prognosis, which is worthy of clinical application.
Objective To investigate the efficacy of neuroendoscopic surgery in the removal of hypertensive intracerebral hemorrhage hematoma. Methods 102 patients with hypertensive intracerebral hemorrhage underwent neurosurgery in our hospital from July 2016 to July 2018 were divided into microscopic group and endoscopic group. 52 patients underwent microscopic hematoma removal(microscopic group) and 50 patients underwent endoscopic hematoma removal(endoscopic group). The operation related indexes(operation time, bleeding volume, hematoma clearance rate), complications(intracranial infection, cerebral infarction) and ADL scores of 6 months after operation were compared and analyzed between the two groups. Results The operation time and bleeding volume of endoscopic group were less than those of microscopic group(P<0.05). The hematoma clearance rate of endoscopic group was higher than that of microscopic group(P<0.05). There was no significant difference between endoscopic group and microscopic group in intracranial infection, cerebral infarction(P>0.05). The ADL score of endoscopic group was better than that of microscopic group 6 months after operation(P<0.05). Conclusion Endoscopic clearance of hypertensive intracerebral hemorrhage has the characteristics of wide visual field, accurate hemostasis, less damage to normal brain tissues and blood vessels, and good prognosis, which is worthy of clinical application.
引文
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[8]杨玉元,万兴忠,马雯霞.应用内窥镜及自制透明套管微创手术治疗高血压性脑出血24例探讨[J].中国临床神经科学,2017,25(6):693-696.
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[10]段国升,朱诚.神经外科手术学[M].北京:人民军医出版社,2008,311.
[2]张亚卓.内镜神经外科学[M].北京:人民卫生出版社,2017,536.
[3]黄进能,韦燕萍,范学政,等.经额中回入路透明套管下神经内镜治疗高血压脑出血的临床效果[J].中国当代医药,2016,23(19):81-83.
[4]于涛,王晓军,路阳,等.神经内镜辅助小骨窗显微手术治疗高血压基底节区脑出血[J].中华神经外科疾病研究杂志,2017,16(2):172-173.
[5]范学政,黄进能,朱寿鸿,等.神经内镜和显微手术治疗脑出血的疗效及卫生经济学比较[J].实用医学杂志,2016,32(18):3007-3010.
[6]吴琦,李巧玉,湛利平.神经内镜下治疗高血压脑出血与其他手术方式的比较[J].实用医学杂志,2017,43(5):375-377.
[7]黄进能,范学政,朱寿鸿,等.神经内镜下脑出血血肿清除术止血技术的探讨[J].中国微侵袭神经外科杂志,2016,21(11):481-483.
[8]杨玉元,万兴忠,马雯霞.应用内窥镜及自制透明套管微创手术治疗高血压性脑出血24例探讨[J].中国临床神经科学,2017,25(6):693-696.
[9]汤浩.高血压脑出血[M].武汉:湖北科学技术出版社,2001:38.
[10]段国升,朱诚.神经外科手术学[M].北京:人民军医出版社,2008,311.