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中华脑科疾病与康复杂志(电子版) ›› 2022, Vol. 12 ›› Issue (02) : 69 -73. doi: 10.3877/cma.j.issn.2095-123X.2022.02.002

临床研究

神经内镜与显微镜手术治疗早期基底节区高血压性脑出血的临床疗效对比
王立忠1, 初君盛2,(), 赵立辉1, 孙慧渊1, 侯青1, 丁奇1, 闫俊飞1, 侯源1, 袁武1, 王唯1   
  1. 1. 075000 张家口市第一医院神经外科
    2. 100070 北京,首都医科大学附属北京天坛医院神经外科
  • 收稿日期:2022-03-04 出版日期:2022-04-15
  • 通信作者: 初君盛
  • 基金资助:
    国家自然科学基金(81571187)

Comparison of clinical efficacy of neuroendoscopy and microscopic surgery on early hypertensive intracerebral hemorrhage in basal ganglia

Lizhong Wang1, Junsheng Chu2,(), Lihui Zhao1, Huiyuan Sun1, Qing Hou1, Qi Ding1, Junfei Yan1, Yuan Hou1, Wu Yuan1, Wei Wang1   

  1. 1. Department of Neurosurgery, Zhangjiakou First Hospital, Zhangjiakou 075000, China
    2. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
  • Received:2022-03-04 Published:2022-04-15
  • Corresponding author: Junsheng Chu
引用本文:

王立忠, 初君盛, 赵立辉, 孙慧渊, 侯青, 丁奇, 闫俊飞, 侯源, 袁武, 王唯. 神经内镜与显微镜手术治疗早期基底节区高血压性脑出血的临床疗效对比[J/OL]. 中华脑科疾病与康复杂志(电子版), 2022, 12(02): 69-73.

Lizhong Wang, Junsheng Chu, Lihui Zhao, Huiyuan Sun, Qing Hou, Qi Ding, Junfei Yan, Yuan Hou, Wu Yuan, Wei Wang. Comparison of clinical efficacy of neuroendoscopy and microscopic surgery on early hypertensive intracerebral hemorrhage in basal ganglia[J/OL]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2022, 12(02): 69-73.

目的

分析神经内镜手术与显微镜手术对早期基底节区高血压性脑出血(HICH)的疗效。

方法

回顾性分析张家口市第一医院神经外科自2016年3月至2021年3月手术治疗的188例早期基底节区HICH患者的临床资料,根据手术方式分为神经内镜组(95例)与显微镜组(93例)。对比分析2组患者术中失血量、手术时间、术后血肿清除率、术后并发症(颅内感染)发生率,以及术后6个月改良Rankin量表(mRs)评分情况。

结果

神经内镜组与显微镜组比较,手术时间明显缩短[(96.6±10.7)min vs(171.3±26.4)min],术中出血量显著减少[(32.8±6.2)mL vs(112.8.0±17.0)mL]、血肿清除率提高(95.9%±4.2% vs 87.4%±6.5%),差异均有统计学意义(P<0.05)。2组并发症发生率比较,差异无统计学意义(P>0.05)。根据术后6个月mRs评分,神经内镜组的预后良好率(26.3%,25/95)高于显微镜组(15.1%,14/93),差异具有统计学意义(P<0.05)。

结论

神经内镜治疗早期基底节区HICH较显微镜手术快速安全、视野清晰,且患者的预后更好。

Objective

To analyze and compare the efficacy of neuroendoscopic surgery and microscopic craniotomy in the treatment of early basal ganglia hypertensive intracerebral hemorrhage (HICH).

Methods

The clinical data of 188 patients with early basal ganglia HICH treated in Neurosurgery Department of Zhangjiakou First Hospital from March 2016 to March 2021 were analyzed retrospectively. According to surgical methods, 95 cases were enrolled into neuroendoscopic group and 93 cases were in microscopic group. The intraoperative blood loss, operation duration, the hematoma clearance rate, the incidence of complications (intracranial infection) and the score of modified Rankin scale (mRs) at 6 months after operation were compared and analyzed between the two groups.

Results

The neuroendoscopy group was compared with the microscope group, the operation duration was significantly shortened [(96.6±10.7) min vs (171.3±26.4) min], the amount of intraoperative bleeding was significantly reduced [(32.8±6.2) mL vs (112.8.0±17.0) mL], and the hematoma clearance rate was increased (95.9%±4.2% vs 87.4%±6.5%), the differences were statistically significant (all P<0.05). There was no significant difference in complications between two groups (P>0.05). According to the mRs score at 6 months after operation, the good prognosis rate of neuroendoscopy group (26.3%, 25/95) was higher than that of microscope group (15.1%, 14/93) (P<0.05).

Conclusion

For the patients with early basal ganglia HICH, less time was needed in neuroendoscopic surgery than that in microscopic surgery. Additionally, there was more clear visual field and better prognosis under neuroendoscopic surgery, indicating that neuroendoscopic surgery is a safer surgery method.

表1 2组患者的一般资料比较
图1 神经内镜治疗基底节区血肿的术中资料 A:颅骨骨瓣大小;B:术中经透明套筒显露血肿情况;C:硬脑膜缝合后,喷涂聚乙二醇类可吸收硬脑膜封合医用胶,防止脑脊液渗漏
表2 2组患者围术期指标比较
图2 2组患者术前术后CT资料 A~B:神经内镜组;A:术前CT示左侧基底节区血肿;B:术后CT示血肿清除;C~D:显微镜组;C:术前CT示右侧基底节区血肿;D:术后CT示血肿清除
表3 2组患者术后6个月改良Rankin量表评分比较[例(%)]
[1]
张长福,谭占国,袁波,等.基底节区高血压性脑出血的临床治疗经验[J].中华神经外科杂志, 2017, 33(12): 1266-1267.
[2]
王晓毅,黄海林,成刚.内镜下颅内血肿清除术与开颅血肿清除术在高血压脑出血中治疗的比较[J].中华神经创伤外科电子杂志, 2020, 6(5): 283-286.
[3]
李少泉,彭文龙,张维,等.微创颅内血肿清除术联合术后尿激酶溶解治疗基底核区高血压脑出血的效果及对神经功能、预后的影响研究[J].解放军医药杂志, 2020, 32(11): 89-93.
[4]
中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国脑出血诊治指南(2019)[J].中华神经科杂志, 2019, 52(12): 994-1005.
[5]
唐华民,周建国,张剑锋,等.两种手术方式治疗高血压脑出血的对比研究[J].中华急诊医学杂志, 2018, 27(4): 425-429.
[6]
Hemphill JC 3rd, Greenberg SM, Anderson CS, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2015, 46(7): 2032-2060.
[7]
Bernardo F, Rebordão L, Machado S, et al. In-hospital and long-term prognosis after spontaneous intracerebral hemorrhage among young adults aged 18-65 years[J]. J Stroke Cerebrovasc Dis, 2019, 28(11): 104350.
[8]
韩鹏,李旭琴,于天元,等.应用神经导航结合神经内镜治疗高血压脑出血的疗效分析[J].中华神经外科杂志, 2018, 34(6): 572-575.
[9]
Kellner CP, Chartrain AG, Nistal DA, et al. The stereotactic intracerebral hemorrhage underwater blood aspiration (SCUBA) technique for minimally invasive endoscopic intracerebral hemorrhage evacuation[J]. J Neurointerv Surg, 2018, 10(8): 771-776.
[10]
杨彦龙,常涛,郭少春,等.神经内镜下治疗幕上高血压脑出血[J].中华神经外科杂志, 2017, 33(7): 733-736.
[11]
Zhao XH, Zhang SZ, Feng J, et al. Efficacy of neuroendoscopic surgery versus craniotomy for supratentorial hypertensive intracerebral hemorrhage: a meta-analysis of randomized controlled trials[J]. Brain Behav, 2019, 9(12): e01471.
[12]
赵伟,袁建伟,宋腾,等.经额中回内镜辅助与常规开颅清除基底节区血肿的对比研究[J].中国实用神经疾病杂志, 2020, 23(17): 1534-1538.
[13]
Xu X, Chen X, Li F, et al. Effectiveness of endoscopic surgery for supratentorial hypertensive intracerebral hemorrhage: a comparison with craniotomy[J]. J Neurosurg, 2018, 128(2): 553-559.
[14]
周贤文,张志远,周世聪,等.神经内镜微创与开颅血肿清除术治疗高血压脑出血的效果比较[J].中国实用医刊, 2020, 47(13): 53-56.
[15]
Eroglu U, Kahilogullari G, Dogan I, et al. Surgical management of supratentorial intracerebral hemorrhages: endoscopic versus open surgery[J]. World Neurosurg, 2018, 114: e60-e65.
[16]
刘俊.内镜下颅内血肿清除术与开颅血肿清除术治疗高血压脑出血的效果比较[J].中国当代医药, 2021, 28(31): 78-81.
[17]
Pasi M, Sugita L, Xiong L, et al. Association of cerebral small vessel disease and cognitive decline after intracerebral hemorrhage[J]. Neurology, 2021, 96(2): e182-e192.
[18]
石立科,向定朝,何建青,等.老年基底核区脑出血患者微创治疗策略选择对不同时期神经功能与预后影响[J].中华老年心脑血管病杂志, 2022, 24(2): 167-170.
[19]
Huang CJ, Liu X, Zhou XT, et al. Neuroendoscopy-assisted evacuation of chronic subdural hematoma with mixed CT density through a novel small bone flap[J]. J Neurol Surg A Cent Eur Neurosurg, 2020, 81(6): 549-554.
[20]
Katsuki M, Kakizawa Y, Nishikawa A, et al. Endoscopic hematoma removal of supratentorial intracerebral hemorrhage under local anesthesia reduces operative time compared to craniotomy[J]. Sci Rep, 2020, 10(1): 10389.
[21]
Kellner CP, Song R, Pan J, et al. Long-term functional outcome following minimally invasive endoscopic intracerebral hemorrhage evacuation[J]. J Neurointerv Surg, 2020, 12(5): 489-494.
[22]
王立忠,初君盛,赵立辉,等.神经内镜手术治疗早期高血压性基底核区出血的临床疗效分析[J].中华神经外科杂志, 2020, 36(12): 1252-1255.
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