神经内镜下脑室血肿清除术与脑室外引流术治疗脑室内出血的疗效分析

doi:10.3877/cma.j.issn.2095-123X.2024.02.004

目的

对比神经内镜辅助下血肿清除术与脑室外引流术治疗脑室内出血（IVH）的临床疗效。

方法

选择高密市人民医院神经外科自2019年1月至2022年2月收治的42例IVH患者，按照随机数字表法分为内镜组与穿刺组，每组21例。内镜组予以神经内镜下脑室血肿清除术治疗，穿刺组行侧脑室外引流术治疗，比较2组患者术后8 h颅脑CT的Graeb评分、尿激酶注射次数、置管时间、术后并发症（颅内感染、再出血、脑积水）发生率、术后3个月患者的神经功能恢复情况（GOS评分）。

结果

内镜组患者术后8 h的血肿清除情况优于穿刺组，Graeb评分低于穿刺组，差异有统计学意义（P<0.05）。内镜组患者尿激酶注射次数、置管时间均少于穿刺组，差异有统计学意义（P<0.05）。内镜组术后并发症的发生率（14.29%）低于穿刺组（38.10%），但差异无统计学意义（P>0.05）。内镜组术后3个月的预后良好率高于穿刺组，差异有统计学意义（P<0.05）。

结论

神经内镜治疗IVH安全可行，是一种潜在的有效手术方式，需要更多临床试验数据的验证。

关键词: 脑室内出血, 神经内镜, 脑室外引流术, 临床疗效

Objective

To compare the clinical efficacy of neuroendoscopic hematoma evacuation and external ventricular drainage in the treatment of intraventricular hemorrhage (IVH).

Methods

A total of 42 patients with IVH admitted to Neurosurgery Department of the People's Hospital of Gaomi from January 2019 to February 2022 were selected and divided into an endoscopy group and a puncture group according to the random number table method, with 21 cases in each group. The endoscopic group was treated with endoscopic evacuation of ventricular hematoma, while the puncture group was treated with lateral external drainage. The Graeb score at the 8 h postoperative time point, the number of urokinase injection, the time of extubation, and the incidence of postoperative complications (intracranial infection, rebleeding, hydrocephalus), and the neurological function recovery of patients 3 months after surgery (GOS score) were compared between the two groups.

Results

The clearance of hematoma in the endoscopic group was better than that in the puncture group at 8 h after surgery, and the Graeb score was lower than that in the puncture group, with a statistically significant difference (P<0.05). The number of urokinase injections and extubation time in the endoscopic group were less than those in the puncture group, and the differences were statistically significant (P<0.05). The incidence of postoperative complications in the endoscopic group (14.29%) was lower than that in the puncture group (38.10%), but the difference was not statistically significant (P>0.05). The good prognosis rate of the endoscopic group at 3 months after surgery was higher than that of the puncture group, and the difference was statistically significant (P<0.05).

Conclusion

Neuroendoscopic treatment of IVH is safe and feasible, and it is a potentially effective surgical method, which needs to be verified by more clinical trial data.

Key words: Intraventricular hemorrhage, Neuroendoscopy, External ventricular drainage, Clinical efficacy

表1 2组患者一般资料的比较（Mean±SD）

Tab.1 Comparison of general information between two groups (Mean±SD)

组别	例数	年龄（岁，Mean±SD）	性别（男/女）	脑出血		出血量（mL，Mean±SD）	术前Graeb评分（分，Mean±SD）	术前GCS评分（分，Mean±SD）
组别	例数	年龄（岁，Mean±SD）	性别（男/女）	丘脑出血破入脑室	原发性脑室出血	出血量（mL，Mean±SD）	术前Graeb评分（分，Mean±SD）	术前GCS评分（分，Mean±SD）
内镜组	21	54.43±11.91	12/9	15	6	25.12±6.43	9.38±1.77	7.91±2.64
穿刺组	21	53.28±12.13	11/10	16	5	23.83±4.45	10.03±1.53	8.21±2.37
χ²/t值		0.232	0.476	0.123		1.078	0.708	1.013
P值		0.817	0.490	0.726		0.103	0.340	0.153

表1 2组患者一般资料的比较（Mean±SD）

Tab.1 Comparison of general information between two groups (Mean±SD)

组别	例数	年龄（岁，Mean±SD）	性别（男/女）	脑出血		出血量（mL，Mean±SD）	术前Graeb评分（分，Mean±SD）	术前GCS评分（分，Mean±SD）
组别	例数	年龄（岁，Mean±SD）	性别（男/女）	丘脑出血破入脑室	原发性脑室出血	出血量（mL，Mean±SD）	术前Graeb评分（分，Mean±SD）	术前GCS评分（分，Mean±SD）
内镜组	21	54.43±11.91	12/9	15	6	25.12±6.43	9.38±1.77	7.91±2.64
穿刺组	21	53.28±12.13	11/10	16	5	23.83±4.45	10.03±1.53	8.21±2.37
χ²/t值		0.232	0.476	0.123		1.078	0.708	1.013
P值		0.817	0.490	0.726		0.103	0.340	0.153

图1 神经内镜下脑室内血肿清除术前术后比较A：术前CT示少量IVH，行脑室穿刺后血肿扩大导致脑室铸型；B：术前3D-Slicer评估血肿体积约51.53 mL；C：术前模拟手术体位，并计算手术路径长度及角度；D：围绕Kocher点做弧形切口后，取骨瓣大小约2.5 cm；E：术后8 h复查头颅CT显示血肿清除良好；F：术后3D-Slicer评估血肿体积约5.80 mL；IVH：脑室内出血

Fig.1 Comparison of imaging before and after endoscopic removal of intraventricular hematoma

表2 2组患者手术指标比较[M（P₂₅，P₇₅）]

Tab.2 Comparison of surgical indicators between two groups [M(P₂₅，P₇₅)]

组别	例数	血肿清除率（%）	尿激酶注射次数（次）	置管时间（d）	术后Graeb评分（分）
内镜组	21	76（69.5，83.0）	2（1，2）	5（4，5）	4（3，5）
穿刺组	21	42（37.5，45.5）	5（5，6）	9（8，10）	9（8，10）
Z值		-5.550	-5.633	-5.639	-5.544
P值		<0.001	<0.001	<0.001	<0.001

表2 2组患者手术指标比较[M（P₂₅，P₇₅）]

Tab.2 Comparison of surgical indicators between two groups [M(P₂₅，P₇₅)]

组别	例数	血肿清除率（%）	尿激酶注射次数（次）	置管时间（d）	术后Graeb评分（分）
内镜组	21	76（69.5，83.0）	2（1，2）	5（4，5）	4（3，5）
穿刺组	21	42（37.5，45.5）	5（5，6）	9（8，10）	9（8，10）
Z值		-5.550	-5.633	-5.639	-5.544
P值		<0.001	<0.001	<0.001	<0.001

表3 2组患者术后并发症情况比较[例（%）]

Tab.3 Comparison of postoperative complications between two groups [n(%)]

组别	例数	颅内感染	再出血	脑积水	合计
内镜组	21	1（4.8）	0（0.0）	2（9.5）	3（14.3）
穿刺组	21	2（9.5）	2（9.5）	4（19.0）	8（38.1）
χ²值					3.079
P值					0.079

表3 2组患者术后并发症情况比较[例（%）]

Tab.3 Comparison of postoperative complications between two groups [n(%)]

组别	例数	颅内感染	再出血	脑积水	合计
内镜组	21	1（4.8）	0（0.0）	2（9.5）	3（14.3）
穿刺组	21	2（9.5）	2（9.5）	4（19.0）	8（38.1）
χ²值					3.079
P值					0.079

表4 2组患者术后3个月的GOS评分比较[例（%）]

Tab.4 Comparison of GOS scores between two groups at 3 months after surgery [n(%)]

组别	例数	5分	4分	3分	2分	1分	预后良好（4~5分）
内镜组	21	4（19.0）	9（42.9）	4（19.5）	3（14.3）	1（4.8）	13（61.9）
穿刺组	21	1（4.8）	5（23.8）	8（38.1）	5（23.8）	2（9.5）	6（28.6）
χ²值						0.000	4.709
P值						1.000	0.030

表4 2组患者术后3个月的GOS评分比较[例（%）]

Tab.4 Comparison of GOS scores between two groups at 3 months after surgery [n(%)]

组别	例数	5分	4分	3分	2分	1分	预后良好（4~5分）
内镜组	21	4（19.0）	9（42.9）	4（19.5）	3（14.3）	1（4.8）	13（61.9）
穿刺组	21	1（4.8）	5（23.8）	8（38.1）	5（23.8）	2（9.5）	6（28.6）
χ²值						0.000	4.709
P值						1.000	0.030

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Efficacy analysis of neuroendoscopic hematoma evacuation and external ventricular drainage in the treatment of intraventricular hemorrhage

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Efficacy analysis of neuroendoscopic hematoma evacuation and external ventricular drainage in the treatment of intraventricular hemorrhage