常规骨瓣开颅与小骨窗开颅治疗基底核区高血压脑出血的临床疗效比较
|
摘要
目的比较常规骨瓣开颅与小骨窗开颅治疗基底核区高血压脑出血的临床疗效。方法回顾性分析2013年1月至2018年3月滁州市第一人民医院收治的53例基底核区高血压脑出血患者的临床资料,根据不同术式分为对照组(29例)和观察组(24例),对照组用取常规骨瓣开颅治疗,观察组采用小骨窗开颅治疗。比较两组患者的血肿复发率、血肿清除率、手术时间、术中出血量、术后住院时间、不良反应及患者术后3个月的生活能力(ADL量表)。结果观察组血肿复发率、血肿基本清除率均低于对照组[6.9%(2/24)比29.2%(8/29)、45.8%(11/24)比75.9%(22/29)](均P<0.05);观察组手术时间、术后住院时间均短于对照组[(116±16)min比(89±13)min、(31±8)d比(23±4)d],术中出血量少于对照组[(215±25)m L比(87±15)m L](P<0.01);术后3个月,观察组生活能力优于对照组(P<0.05)。结论小骨窗开颅治疗基底核区高血压脑出血的创伤小、术中出血量少,术后血肿复发率低,可有效缩短手术时间和患者住院时间,提高患者术后生活能力。
Objective To compare the efficacy of conventional bone flap craniotomy and small bone window craniotomy in the treatment of basal ganglia intracerebral hemorrhage of hypertension.Methods The clinical data of 53 patients with cerebral hemorrhage of hypertension treated with conventional craniotomy or small bone window craniotomy in Chuzhou First People's Hospital form Jan.2013 to mar.2018 were retrospectively analyzed.According to different surgical procedures,they were divided into a control group(29 cases) and an observation group(24 cases),and the control group was treated with conventional bone,while the observation group underwent small bone window craniotomy.The hematoma recurrence rate,hematoma clearance rate,operation time,intraoperative blood loss,postoperative hospital stay,adverse reaction and activity of daily living(ADL) 3 months after surgery were compared between the two groups.Results The recurrence rate and the basic clearance rate of hematoma in the observation group were lower than those in the control group[6.9%(2/24) vs29.2%(8/29),45.8%(11/24) vs 75.9%(22/29) ](P < 0.05).The operation time and postoperative hospital stay in the observation group were shorter than those in the control group[(116 ± 16) min vs(89 ± 13) min,(31 ± 8) d vs(23 ±4) d],the amount of intraoperative bleeding was less than that of the control group[(215 ± 25) m L vs(87 ± 15) m L](P <0.01);3 months after operation,the living ability of the observation group was better than that of the control group(P <0.05).Conclusion Small bone window craniotomy for the treatment of hypertensive intracerebral hemorrhage in the basal ganglia is less traumatic with less intraoperative bleeding,lower postoperative recurrence rate of hematoma,and it can effectively shorten the time of operation and the hospitalization time,and improve the living ability after operation.
Objective To compare the efficacy of conventional bone flap craniotomy and small bone window craniotomy in the treatment of basal ganglia intracerebral hemorrhage of hypertension.Methods The clinical data of 53 patients with cerebral hemorrhage of hypertension treated with conventional craniotomy or small bone window craniotomy in Chuzhou First People's Hospital form Jan.2013 to mar.2018 were retrospectively analyzed.According to different surgical procedures,they were divided into a control group(29 cases) and an observation group(24 cases),and the control group was treated with conventional bone,while the observation group underwent small bone window craniotomy.The hematoma recurrence rate,hematoma clearance rate,operation time,intraoperative blood loss,postoperative hospital stay,adverse reaction and activity of daily living(ADL) 3 months after surgery were compared between the two groups.Results The recurrence rate and the basic clearance rate of hematoma in the observation group were lower than those in the control group[6.9%(2/24) vs29.2%(8/29),45.8%(11/24) vs 75.9%(22/29) ](P < 0.05).The operation time and postoperative hospital stay in the observation group were shorter than those in the control group[(116 ± 16) min vs(89 ± 13) min,(31 ± 8) d vs(23 ±4) d],the amount of intraoperative bleeding was less than that of the control group[(215 ± 25) m L vs(87 ± 15) m L](P <0.01);3 months after operation,the living ability of the observation group was better than that of the control group(P <0.05).Conclusion Small bone window craniotomy for the treatment of hypertensive intracerebral hemorrhage in the basal ganglia is less traumatic with less intraoperative bleeding,lower postoperative recurrence rate of hematoma,and it can effectively shorten the time of operation and the hospitalization time,and improve the living ability after operation.
引文
[1]薛雷.微创穿刺术与小骨窗开颅术治疗老年脑出血的疗效比较[J].山东医药,2017,57(46):92-94.
[2]李建军,徐文中,何阳,等.小骨窗开颅手术与骨瓣开颅血肿清除治疗基底节区高血压脑出血的疗效比较[J].内蒙古医学杂志,2014,46(9):1111-1113.
[3]Chen G,Ping L,Zhou S,et al.Early prediction of death in acute hypertensive intracerebral hemorrhage[J].Exp Ther Med,2016,11(1):83-88.
[4]陈建勇.小骨窗开颅血肿清除术与大骨瓣开颅血肿清除术治疗高血压脑出血的疗效比较[J].中国实用医药,2016,11(17):132-133.
[5]孙立.超早期小骨窗开颅显微手术治疗基底节区高血压脑出血的疗效观察[J].立体定向和功能性神经外科杂志,2015,30(1):39-41.
[6]韩繁龙,张国来,吴生贵,等.小骨窗与大骨瓣开颅血肿清除术治疗高血压脑出血的疗效分析[J].现代生物医学进展,2016,16(33):6542-6545.
[7]李德昊.去骨瓣减压术在高血压脑出血手术治疗中的应用[J].中国实用神经疾病杂志,2015,18(5):20-22.
[8]金杰,胡胜,刘强.对比开颅血肿清除术和微创穿刺术治疗高血压脑出血的可行性与有效性[J].基因组学与应用生物学,2017,36(6):2255-2258.
[9]Liu Z,Chen Q,Tian D,et al.Clinical significance of dynamic monitoring by transcranial doppler ultrasound and intracranial pressure monitor after surgery of hypertensive intracerebral hemorrhage[J].Int J Clin Exp Med,2015,8(7):11456-11462.
[10]黄志刚,魏剑波,李密,等.高血压脑出血手术治疗中血肿清除加去骨瓣减压术的效果[J].中国地方病防治杂志,2017,32(8):858.
[11]Yan YF,Ru DW,Du JR,et al.The clinical efficacy of neuronavigation-assisted minimally invasive operation on hypertensive basal ganglia hemorrhage[J].Eur Rev Med Pharmacol Sci,2015,19(14):2614-2620.
[12]贾磊,周德宝.三种手术治疗基底节区高血压脑出血效果比较[J].山东医药,2016,56(26):65-66.
[13]党帅.比较三种不同手术方式对基底节脑出血患者长期神经功能及颅内感染的影响[J].国际神经病学神经外科学杂志,2016,43(6):526-530.
[14]刘斌,喻军华.小骨窗开颅显微手术与大骨瓣开颅术治疗高血压基底节区脑出血临床效果比较[J].解放军医药杂志,2018,30(4):65-67.
[15]严亿军.小骨窗经侧裂入路显微手术治疗高血压基底节脑出血患者回顾性分析[J].国际神经病学神经外科学杂志,2016,43(1):16-18.
[16]Feng Y,He J,Liu B,et al.Endoscope-Assisted Keyhole Technique for Hypertensive Cerebral Hemorrhage in Elderly Patients:A Randomized Controlled Study in 184 Patients[J].Turk Neurosurg,2016,26(1):84-89.
[17]李毅钊,钟志坚,孙海鹰,等.丘脑基底节区高血压脑出血的显微外科治疗及预后相关因素分析[J].国际神经病学神经外科学杂志,2016,43(1):12-15.
[18]Hu YZ,Wang JW,Luo BY.Epidemiological and clinical characteristics of 266 cases of intracerebral hemorrhage in Hangzhou,China[J].J Zhejiang Univ Sci B,2013,14(6):496-504.
[19]钱明,赵伟,蔡刚,等.小骨窗微创手术与开颅手术治疗高血压基底节脑出血的疗效比较[J].实用医学杂志,2015,31(23):3889-3891.
[20]宋大勇,赵军,张宁,等.不同手术方式治疗老年早期基底节区高血压脑出血患者疗效及预后随访[J].中华老年医学杂志,2017,36(7):742-745.
[2]李建军,徐文中,何阳,等.小骨窗开颅手术与骨瓣开颅血肿清除治疗基底节区高血压脑出血的疗效比较[J].内蒙古医学杂志,2014,46(9):1111-1113.
[3]Chen G,Ping L,Zhou S,et al.Early prediction of death in acute hypertensive intracerebral hemorrhage[J].Exp Ther Med,2016,11(1):83-88.
[4]陈建勇.小骨窗开颅血肿清除术与大骨瓣开颅血肿清除术治疗高血压脑出血的疗效比较[J].中国实用医药,2016,11(17):132-133.
[5]孙立.超早期小骨窗开颅显微手术治疗基底节区高血压脑出血的疗效观察[J].立体定向和功能性神经外科杂志,2015,30(1):39-41.
[6]韩繁龙,张国来,吴生贵,等.小骨窗与大骨瓣开颅血肿清除术治疗高血压脑出血的疗效分析[J].现代生物医学进展,2016,16(33):6542-6545.
[7]李德昊.去骨瓣减压术在高血压脑出血手术治疗中的应用[J].中国实用神经疾病杂志,2015,18(5):20-22.
[8]金杰,胡胜,刘强.对比开颅血肿清除术和微创穿刺术治疗高血压脑出血的可行性与有效性[J].基因组学与应用生物学,2017,36(6):2255-2258.
[9]Liu Z,Chen Q,Tian D,et al.Clinical significance of dynamic monitoring by transcranial doppler ultrasound and intracranial pressure monitor after surgery of hypertensive intracerebral hemorrhage[J].Int J Clin Exp Med,2015,8(7):11456-11462.
[10]黄志刚,魏剑波,李密,等.高血压脑出血手术治疗中血肿清除加去骨瓣减压术的效果[J].中国地方病防治杂志,2017,32(8):858.
[11]Yan YF,Ru DW,Du JR,et al.The clinical efficacy of neuronavigation-assisted minimally invasive operation on hypertensive basal ganglia hemorrhage[J].Eur Rev Med Pharmacol Sci,2015,19(14):2614-2620.
[12]贾磊,周德宝.三种手术治疗基底节区高血压脑出血效果比较[J].山东医药,2016,56(26):65-66.
[13]党帅.比较三种不同手术方式对基底节脑出血患者长期神经功能及颅内感染的影响[J].国际神经病学神经外科学杂志,2016,43(6):526-530.
[14]刘斌,喻军华.小骨窗开颅显微手术与大骨瓣开颅术治疗高血压基底节区脑出血临床效果比较[J].解放军医药杂志,2018,30(4):65-67.
[15]严亿军.小骨窗经侧裂入路显微手术治疗高血压基底节脑出血患者回顾性分析[J].国际神经病学神经外科学杂志,2016,43(1):16-18.
[16]Feng Y,He J,Liu B,et al.Endoscope-Assisted Keyhole Technique for Hypertensive Cerebral Hemorrhage in Elderly Patients:A Randomized Controlled Study in 184 Patients[J].Turk Neurosurg,2016,26(1):84-89.
[17]李毅钊,钟志坚,孙海鹰,等.丘脑基底节区高血压脑出血的显微外科治疗及预后相关因素分析[J].国际神经病学神经外科学杂志,2016,43(1):12-15.
[18]Hu YZ,Wang JW,Luo BY.Epidemiological and clinical characteristics of 266 cases of intracerebral hemorrhage in Hangzhou,China[J].J Zhejiang Univ Sci B,2013,14(6):496-504.
[19]钱明,赵伟,蔡刚,等.小骨窗微创手术与开颅手术治疗高血压基底节脑出血的疗效比较[J].实用医学杂志,2015,31(23):3889-3891.
[20]宋大勇,赵军,张宁,等.不同手术方式治疗老年早期基底节区高血压脑出血患者疗效及预后随访[J].中华老年医学杂志,2017,36(7):742-745.