经额入路神经内镜清除高血压基底节出血疗效分析
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摘要
目的研究经额入路神经内镜清除高血压基底节出血的安全性和有效性。方法高血压脑出血患者105例,采用骨孔或小骨瓣神经内镜手术治疗(内镜组) 50例,骨瓣开颅显微镜下经侧裂手术治疗(显微镜组) 55例,观察2组疗效和并发症。结果内镜治疗组手术时间、术中出血量低于显微镜组,血肿清除率高于显微镜组,差异有统计学意义(P <0. 05)。内镜治疗组术后再出血、肺部感染、肾衰竭、脑功能衰竭、继发癫痫等并发症发生率均低于显微镜组,但差异无统计学意义(P> 0. 05)。内镜治疗组并发症总发生率低于对照组(P <0. 05)。2组术后神经功能缺损情况均逐渐好转,NIHSS评分有降低趋势,其中术后2周开始内镜治疗组NIHSS评分低于显微镜组,差异有统计学意义(P <0. 05)。6个月后,内镜组失访2例,显微镜组失访3例。内镜组患者预生存质量高于对照组,内镜组mRS评分低于对照组,差异有统计学意义(P <0. 05)。结论经额入路神经内镜清除高血压基底节出血微创,安全,能够改善患者的预后。
Objective To investigate the therapeutic effects and safety of neuroendoscopy via frontal approach in cleaning hypertensive basal ganglia hemorrhage. Methods A total of 105 patients with hypertensive cerebral hemorrhage were divided into endoscope group( n = 50) and microscope group( n = 55). The patients in endoscope group were treated by endoscopic surgery with bone hole or small bone flap,however,the patients in microscope group were treated by open craniotomy under the craniotomy microscope. After surgery,the therapeutic effects and complications were observed and comapred between the two groups. Results The operation time and intraoperative hemorrhage volume in endoscope group were significantly lower than those in microscope group,however,the hematoma clearance rate in endoscope group was significantly higher than that in microscope group( P < 0. 05). The incidences of postoperative hemorrhage,pulmonary infection,renal failure,brain failure and secondary epilepsy in endoscope group were lower than those in microscope group,but there were no significant differences( P > 0. 05). The total incidence rate of complications in endoscope group was significantly lower than that in microscope group( P < 0. 05). Moreover the NIHSS scores at 2 weeks after surgery in endoscope group were significantly lower than those in microscope group( P < 0. 05). At 6 months after operation,the follow up was lost in 2 cases of endoscope group and 3 cases in microscope group. In addition the survival quality in endoscope group was higher than that in microscope group,and the mRS scores were significantly lower than those in microscope group( P < 0. 05). Conclusion The neuroendoscopy via frontal approach in cleaning hypertensive basal ganglia hemorrhage is minimally invasive and safe,which can improve the prognosis of patients.
Objective To investigate the therapeutic effects and safety of neuroendoscopy via frontal approach in cleaning hypertensive basal ganglia hemorrhage. Methods A total of 105 patients with hypertensive cerebral hemorrhage were divided into endoscope group( n = 50) and microscope group( n = 55). The patients in endoscope group were treated by endoscopic surgery with bone hole or small bone flap,however,the patients in microscope group were treated by open craniotomy under the craniotomy microscope. After surgery,the therapeutic effects and complications were observed and comapred between the two groups. Results The operation time and intraoperative hemorrhage volume in endoscope group were significantly lower than those in microscope group,however,the hematoma clearance rate in endoscope group was significantly higher than that in microscope group( P < 0. 05). The incidences of postoperative hemorrhage,pulmonary infection,renal failure,brain failure and secondary epilepsy in endoscope group were lower than those in microscope group,but there were no significant differences( P > 0. 05). The total incidence rate of complications in endoscope group was significantly lower than that in microscope group( P < 0. 05). Moreover the NIHSS scores at 2 weeks after surgery in endoscope group were significantly lower than those in microscope group( P < 0. 05). At 6 months after operation,the follow up was lost in 2 cases of endoscope group and 3 cases in microscope group. In addition the survival quality in endoscope group was higher than that in microscope group,and the mRS scores were significantly lower than those in microscope group( P < 0. 05). Conclusion The neuroendoscopy via frontal approach in cleaning hypertensive basal ganglia hemorrhage is minimally invasive and safe,which can improve the prognosis of patients.
引文
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2王希佳.依达拉奉联合尼莫地平治疗高血压脑出血对神经功能和血肿及水肿的影响.河北医药,2016,38:547-549.
3王文志,刘红梅,李涤.基底节区脑出血微创穿刺术与内科保守治疗临床随机对照研究.第三届全国颅内血肿微创穿刺粉碎清除术学术研究会论文集,2004.9.
4欧艳.NIHSS评分与SSS评分对脑梗死急诊溶栓后出血转化的预测价值.实用医学杂志,2014,30:3124-3126.
5范玉华,姬晓昙,蓝琳芳.国内脑卒中临床试验疗效判断方法中改良Rankin评分的应用现状.中国神经精神疾病杂志,2015,41:412-415.
6游潮,刘鸣,李浩.高血压脑出血诊治中的若干问题.中国脑血管病杂志,2011,8:169-171.
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8李浩,张帆,刘文科,等.高血压脑出血手术适应证分析及疗效探讨.中华神经外科杂志,2011,27:240-243.
9游潮,李浩.进一步重视和规范高血压脑出血的外科治疗.中华神经外科杂志,2011,27:757-758.
10杨理媛,孙晓川.治疗高血压脑出血三种术式疗效和预后研究.中国全科医学,2012,15:1040-1042.
11陈祎招,徐如祥,赛力克,等.高血压脑出血神经内镜微创手术与开颅血肿清除术的临床比较分析.中国神经精神疾病杂志,2010,36:616-619.
12林发牧,许小兵.神经内镜与显微手术治疗高血压基底节区脑出血的效果比较.广东医学,2014,35:2224-2226.
13张文学.神经内镜与显微手术两种术式治疗高血压基底节区脑出血的疗效对比分析.中国现代药物应用,2016,10:33-34.
14仲雷,遇旭东,丁建军,等.神经内镜与显微手术治疗高血压基底节区脑出血的疗效比较.中国医疗器械信息,2017,23:14-16.
2王希佳.依达拉奉联合尼莫地平治疗高血压脑出血对神经功能和血肿及水肿的影响.河北医药,2016,38:547-549.
3王文志,刘红梅,李涤.基底节区脑出血微创穿刺术与内科保守治疗临床随机对照研究.第三届全国颅内血肿微创穿刺粉碎清除术学术研究会论文集,2004.9.
4欧艳.NIHSS评分与SSS评分对脑梗死急诊溶栓后出血转化的预测价值.实用医学杂志,2014,30:3124-3126.
5范玉华,姬晓昙,蓝琳芳.国内脑卒中临床试验疗效判断方法中改良Rankin评分的应用现状.中国神经精神疾病杂志,2015,41:412-415.
6游潮,刘鸣,李浩.高血压脑出血诊治中的若干问题.中国脑血管病杂志,2011,8:169-171.
7邓平,吴晓牧.高血压脑出血病理生理机制研究进展.中华脑血管病杂志:电子版,2010,4:19-26.
8李浩,张帆,刘文科,等.高血压脑出血手术适应证分析及疗效探讨.中华神经外科杂志,2011,27:240-243.
9游潮,李浩.进一步重视和规范高血压脑出血的外科治疗.中华神经外科杂志,2011,27:757-758.
10杨理媛,孙晓川.治疗高血压脑出血三种术式疗效和预后研究.中国全科医学,2012,15:1040-1042.
11陈祎招,徐如祥,赛力克,等.高血压脑出血神经内镜微创手术与开颅血肿清除术的临床比较分析.中国神经精神疾病杂志,2010,36:616-619.
12林发牧,许小兵.神经内镜与显微手术治疗高血压基底节区脑出血的效果比较.广东医学,2014,35:2224-2226.
13张文学.神经内镜与显微手术两种术式治疗高血压基底节区脑出血的疗效对比分析.中国现代药物应用,2016,10:33-34.
14仲雷,遇旭东,丁建军,等.神经内镜与显微手术治疗高血压基底节区脑出血的疗效比较.中国医疗器械信息,2017,23:14-16.