神经内镜与开颅血肿清除治疗高血压脑出血的疗效对比
摘要
目的:探讨神经内镜与开颅血肿清除两种手术方法治疗高血压脑出血疗效的差异。方法:对我院2000.1～2005.5期间收治的40例高血压脑出血手术病例进行回顾分析,所有病例按照血肿≤40ml或>40ml分为两个区段,比较每个区段中内镜和开颅两组病人的预后情况。结果:血肿≤40ml区段,两种治疗方法的有效率和死亡率均无统计学差别,内镜组病人显效率略较开颅组高;血肿>40ml区段,开颅组病人治疗的有效率较内镜组高(p<0.05),而两组死亡率无统计学差别。结论:高血压脑出血血肿≤40ml患者,行神经内镜手术创伤小,疗效满意;血肿>40ml患者,开颅血肿清除术优于神经内镜手术。
Objective To investigate and compare the therapeutic effect of the two surgical management below in hypertensive intracerebral hemorrhage(HICH), endoscopic management and craniotomic hematoma evacuation. Methods From January 2001 to May 2005, forty patients of HICH in our hospital underwent endoscopic management or craniotomic hematoma evacuation. The patients with intracerebral hematoma volume(ICH) ≤40ml and >40ml were divided into two groups. In each group, the therapeutic effect of the two surgical management was compared. Results In the group of ICH≤40ml, there was no difference in therapeutic effect between endoscopic management and craniotomic hematoma evacuation. But in the group of ICH>40ml, the outcome of craniotomic hematoma evacuation was better. Conclusion Endoscopic management might fit patients of HICH whose ICH was less than 40ml, but it should be less suitable than craniotomic hematoma evacuation in treating a bigger hematoma.
Objective To investigate and compare the therapeutic effect of the two surgical management below in hypertensive intracerebral hemorrhage(HICH), endoscopic management and craniotomic hematoma evacuation. Methods From January 2001 to May 2005, forty patients of HICH in our hospital underwent endoscopic management or craniotomic hematoma evacuation. The patients with intracerebral hematoma volume(ICH) ≤40ml and >40ml were divided into two groups. In each group, the therapeutic effect of the two surgical management was compared. Results In the group of ICH≤40ml, there was no difference in therapeutic effect between endoscopic management and craniotomic hematoma evacuation. But in the group of ICH>40ml, the outcome of craniotomic hematoma evacuation was better. Conclusion Endoscopic management might fit patients of HICH whose ICH was less than 40ml, but it should be less suitable than craniotomic hematoma evacuation in treating a bigger hematoma.
引文
1 王忠诚.王忠诚神经外科学[M].武汉:湖北科学技术出版社.2005:864-871.
2 蒋大介,杨树源.实用神经外科手术学[M].上海:上海科学技术出版社,1988:366～372.
3 Thiex R, Rohde V, Rohde I, et al. Frame-based and frameless stereotactic hematoma puncture and subsequent fibrinolytic therapy for the treatment of spontaneous intracerebral hemorrhage. J Neurol,2004,251:1443-50.
4 Nakano T, Ohkuma H, Ebina K, et al. Neuroendoscopic surgery for intracerebral haemorrhage -comparison with traditional therapies. Minim Invasive Neurosurg, 2003, 46:278-83.
5 郭希高,欧阳同伟,容耔耘.高血压脑出血超早期手术开颅小骨窗优选设计的临床研究.中华神经医学杂志,2005,2,161-3.
6 Qiu Y, Lin Y, Tian X, et al. Hypertensive intracranial hematomas: endoscopic-assisted keyhole evacuation and application of patent viewing dissector. Chin Med J(Engl), 2003,116:195-9.
7 JhoD. Endoscopic endonasal pituitary surgery: evolution of surgical technique and equipment in 150 operations. Minm Invasive Neurosurg,2001,44:1-5.
8 KatoY. Endoscope-assisted microsurgery for cerebra aneurysms. Minm Invasive Neurosurg,2000,43:91-95.
9 Auer LM, Deinsberger W, Niederkorn K, et al. Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: a randomized study. J Neurosurg, 1989,70:530-5.
10 Danchin AG. A comparison of the frequency of hemorrhage recurrence in the surgical treatment of a massive intracerebral hematoma as dependent on the method of surgical intervention. LikSprava,2000,1:74-76.
11 Hsieh PC, Cho DY, Lee WY, et al. Endoscopic evacuation of putaminal hemorrhage: how to improve the efficiency of hematoma evacuation. Surgical Neurology, 2005,64:147-153.
12 及时雨,许鸿云.单纯神经内镜手术治疗高血压脑出血探讨.河南外科学杂志,2004,10:34-35.
13 Wagner KR, Xi G, Hua Y, et al. Early metabolic alteration in edematous perihematomal brain regions following experimintal intracerebral hemorrhage. J Neurosurg,1998,88:1058-65.
14 Lee KR, Colon GP, Betz AL, et al. Edema from intracerebral hemorrhage: the role of thrombin. J Neurosurg,1996,84:91-6.
15 查(韦华)光,李安民,付相平.立体定向神经内窥镜手术治疗高血压性脑出血17例.中国脑血管病杂志,2004,1:468-9.
16 Nishihara T, Nagata K, Tanaka S, et al. Newly developed endoscopic instruments for the removal of intracerebral hematoma. Neurocrit Care,2005,2:67-74.
2 蒋大介,杨树源.实用神经外科手术学[M].上海:上海科学技术出版社,1988:366～372.
3 Thiex R, Rohde V, Rohde I, et al. Frame-based and frameless stereotactic hematoma puncture and subsequent fibrinolytic therapy for the treatment of spontaneous intracerebral hemorrhage. J Neurol,2004,251:1443-50.
4 Nakano T, Ohkuma H, Ebina K, et al. Neuroendoscopic surgery for intracerebral haemorrhage -comparison with traditional therapies. Minim Invasive Neurosurg, 2003, 46:278-83.
5 郭希高,欧阳同伟,容耔耘.高血压脑出血超早期手术开颅小骨窗优选设计的临床研究.中华神经医学杂志,2005,2,161-3.
6 Qiu Y, Lin Y, Tian X, et al. Hypertensive intracranial hematomas: endoscopic-assisted keyhole evacuation and application of patent viewing dissector. Chin Med J(Engl), 2003,116:195-9.
7 JhoD. Endoscopic endonasal pituitary surgery: evolution of surgical technique and equipment in 150 operations. Minm Invasive Neurosurg,2001,44:1-5.
8 KatoY. Endoscope-assisted microsurgery for cerebra aneurysms. Minm Invasive Neurosurg,2000,43:91-95.
9 Auer LM, Deinsberger W, Niederkorn K, et al. Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: a randomized study. J Neurosurg, 1989,70:530-5.
10 Danchin AG. A comparison of the frequency of hemorrhage recurrence in the surgical treatment of a massive intracerebral hematoma as dependent on the method of surgical intervention. LikSprava,2000,1:74-76.
11 Hsieh PC, Cho DY, Lee WY, et al. Endoscopic evacuation of putaminal hemorrhage: how to improve the efficiency of hematoma evacuation. Surgical Neurology, 2005,64:147-153.
12 及时雨,许鸿云.单纯神经内镜手术治疗高血压脑出血探讨.河南外科学杂志,2004,10:34-35.
13 Wagner KR, Xi G, Hua Y, et al. Early metabolic alteration in edematous perihematomal brain regions following experimintal intracerebral hemorrhage. J Neurosurg,1998,88:1058-65.
14 Lee KR, Colon GP, Betz AL, et al. Edema from intracerebral hemorrhage: the role of thrombin. J Neurosurg,1996,84:91-6.
15 查(韦华)光,李安民,付相平.立体定向神经内窥镜手术治疗高血压性脑出血17例.中国脑血管病杂志,2004,1:468-9.
16 Nishihara T, Nagata K, Tanaka S, et al. Newly developed endoscopic instruments for the removal of intracerebral hematoma. Neurocrit Care,2005,2:67-74.