内镜血肿清除术与钻孔引流术治疗高血压基底节出血的对比研究
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摘要
目的比较2种微创手术方法治疗高血压基底节出血的疗效。方法对80例高血压基底节出血患者进行随机对照研究,40例采用内镜血肿清除术,40例采用钻孔引流术、术后辅助尿激酶纤溶治疗并引流,手术均使用神经导航进行定位指导,比较其疗效。结果按血肿量40 mL为限分为2个组,血肿量小于40 mL为Ⅰ组,血肿量大于或等于40 mL为Ⅱ组,两组疗效无显著性差异(P>0.05),术后第1、3、7天,Ⅰ、Ⅱ组钻孔术组血肿清除率分别为(52.18±15.74)%vs.(40.55±15.35)%、(70.95±13.33)vs.(58.57±14.49)%、(74.50±19.05)%vs.(71.48±5.11)%,Ⅱ组内镜术组疗效优于钻孔术组(均P<0.05)。结论 2种微创手术方式均能有效清除血肿,针对较大血肿,应优先考虑内镜血肿清除术。
Objective To compare the effect of two minimally invasive methods on the treatment of hypertensive basal ganglia hemorrhage.Methods A randomized controlled study of 80 patients with hypertensive basal ganglia hemorrhage was carried out.Forty patients were treated with endoscopic hematoma evacuation,40 patients were operated by burr hole drilling and drainage with aid of urokinase injection,and the operation was guided by the neuronavigation and the therapy effect was compared.All patients were divided into two subgroups according to the volume of hematoma,subgroup I with volume above 40 mL and subgroup Ⅱ with volume below 40 mL.Results The results showed that there was no significant difference between the two groups(P>0.05),while the clearance rate of endoscopic hematoma with hematoma volume of more than 40 mL was better than that of the burr hole drilling.The clearance rate of two subgroups 1 day,3 days and 7 days after surgery was(52.18±15.74)% vs.(40.55±15.35)%,(70.95±13.33)% vs.(58.57±14.49)%,and(74.50±19.05)% vs.(71.48±5.11)%,respectively(P<0.05).Conclusion Two minimally invasive surgical methods can effectively evacuate hematoma.For patients with large hematoma,endoscopic hematoma removal should be given in priority.
Objective To compare the effect of two minimally invasive methods on the treatment of hypertensive basal ganglia hemorrhage.Methods A randomized controlled study of 80 patients with hypertensive basal ganglia hemorrhage was carried out.Forty patients were treated with endoscopic hematoma evacuation,40 patients were operated by burr hole drilling and drainage with aid of urokinase injection,and the operation was guided by the neuronavigation and the therapy effect was compared.All patients were divided into two subgroups according to the volume of hematoma,subgroup I with volume above 40 mL and subgroup Ⅱ with volume below 40 mL.Results The results showed that there was no significant difference between the two groups(P>0.05),while the clearance rate of endoscopic hematoma with hematoma volume of more than 40 mL was better than that of the burr hole drilling.The clearance rate of two subgroups 1 day,3 days and 7 days after surgery was(52.18±15.74)% vs.(40.55±15.35)%,(70.95±13.33)% vs.(58.57±14.49)%,and(74.50±19.05)% vs.(71.48±5.11)%,respectively(P<0.05).Conclusion Two minimally invasive surgical methods can effectively evacuate hematoma.For patients with large hematoma,endoscopic hematoma removal should be given in priority.
引文
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[12] 林涛,车海江,冯磊,等.立体定向手术治疗高血压基底节脑出血[J].中华神经外科疾病研究杂志,2012,11(5):469-470.
[13] 曹英肖,王风聚,刘振波,等.脑出血后不同时间血肿周围病理及超微结构变化的研究[J].中华神经外科杂志,2013,29(8):829-831.
[2] Ironside N,Chen C J,Ding D,et al.Perihematomal edema after spontaneous intracerebral hemorrhage[J].Stroke,2019,50(6):1626-1633.
[3] Mendelow A D,Gregson B A,Fernandes H M,et al.Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage(STICH):a randomised trial[J].Lancet,2005,365(9457):387-397.
[4] Mendelow A D.Operation versus non-operative treatment for spontaneous supratentorial intracerebral haemorrhage:Is a change in current clinical practice required?[J].Neurol India,2017,65(4):759-760.
[5] 吕新兵,王刚,尹连虎,等.高血压基底节区脑出血不同手术方式治疗体会[J].中华神经外科杂志,2012,28(8):763.
[6] 王昆鹏,王维兴,杨婕,等.自发性脑出血的外科手术治疗[J].国际脑血管病杂志,2014,22(4):300-303.
[7] Haley M D,Gregson B A.,Mould W A,et al.Retrospective methods analysis of semiautomated intracerebral hemorrhage volume quantification from a selection of the STICH Ⅱ Cohort(Early Surgery Versus Initial Conservative Treatment in Patients With Spontaneous Supratentorial Lobar Intracerebral Haematomas)[J].Stroke,2018,49(2):325-332.
[8] Mould W A,Carhuapoma J R,Muschelli J,et al.MISTIE Investigators.Minimally invasive surgery plus recombinant tissue-type plasminogen activator for intracerebral hemorrhage evacuation decreases perihematomal edema[J].Stroke,2013,44(3):627-634.
[9] Nagasaka T,Tsugeno M,Ikeda H,et al.Early recovery and better evacuation rate in neuroendoscopic surgery for spontaneous intracerebral hemorrhage using a multifunctional cannula:preliminary study in comparison with craniotomy[J].J Stroke Cerebrovasc Dis,2011,20(3):208-213.
[10] Basaldella L,Marton E,Fiorindi A.External ventricular dr-ainage alone versus endoscopic surgery for severe intraventricular hemorrhage:a comparative retrospective analysis on outcome and shunt dpendency[J].Neurosurg Focus,2012,32(4):4-11.
[11] 张福征,王才永,张磊,等.神经内镜与开颅手术治疗高血压脑出血的疗效比较[J].中华神经外科杂志,2015,31(1):19-21.
[12] 林涛,车海江,冯磊,等.立体定向手术治疗高血压基底节脑出血[J].中华神经外科疾病研究杂志,2012,11(5):469-470.
[13] 曹英肖,王风聚,刘振波,等.脑出血后不同时间血肿周围病理及超微结构变化的研究[J].中华神经外科杂志,2013,29(8):829-831.