内镜手术治疗高血压脑出血合并脑疝患者的疗效和安全性探讨

Therapeutic effect and safety on neuro-endoscopic surgery for hypertensive cerebral hemorrhage with concurrent cerebral herniation

摘要:

摘要：目的??研究采用神经内镜手术清除高血压脑出血合并脑疝患者的颅内血肿同时保留骨瓣的疗效和安全性。方法?回顾性分析该科2015年1月-2017年6月行手术治疗的高血压脑出血合并一侧瞳孔散大的患者，共计54例。排除双侧瞳孔散大，术前行床边CT血管造影（CTA）排除合并动脉瘤、动静畸形和烟雾病等。其中神经内镜手术组23例，开颅手术组31例。比较两组病例的手术时间、术中出血量、血肿清除率，术后再出血、脑梗死和死亡的发生率。术后3个月行格拉斯哥预后评分（GOS）。结果?神经内镜治疗组在手术时间、术中出血量上均优于开颅组，两组间差异有统计学意义；而两组间血肿清除率、术后再出血和脑梗死的发生率差异无统计学意义。尽管术后3个月GOS评分总体上内镜组与开颅组无显著差异，但内镜组植物生存率与重残率较开颅组有下降，而轻残率明显增加。结论?神经内镜手术治疗脑出血合并脑疝患者手术安全，同时损伤小、降低了植物生存率与重残率。

Abstract:

Abstract: Objective?To investigate the therapeutic effect and safety on neuroendoscopy-assisted hematoma-evacuation surgery followed by bone flap repositioning for hypertensive cerebral hemorrhage with concurrent cerebral herniation.?Methods?Clinical data of 54 patients with hypertensive cerebral hemorrhage and concurrent unilateral mydriasis from Jan, 2015 to Jun, 2017 underwent hematoma-evacuation surgery were retrospectively analyzed. Patients who presented with bilateral mydriasis or were diagnosed with intracranial aneurysm, arteriovenous malformation, or moyamoya disease were precedently excluded. Neuroendoscopy-assisted hematoma-evacuation surgery followed by bone flap repositioning was performed in 23 patients and ordinary hematoma-evacuation craniectomy followed by bone flap removal was in the rest 31 patients, respectively. The surgical duration, intraoperative blood loss, thoroughness of hematoma-evacuation, postoperative rehemorrhage, cerebral infarction, death, and 3-mon GOS (Glasgow Outcome Scale) score were compared between the two groups.?Results?Neuroendoscopic surgery took advantages over ordinary craniectomy in the surgical duration, intraoperative blood loss, evidenced by the significant statistical differences. However, there was no statistical difference in thoroughness of hematoma-evacuation, the incidence of postoperative rehemorrhage and cerebral infarction between the two groups. Although the overall 3-month postoperative GOS score of patients in the neuroendoscopic surgery group seemed no significant difference compared with the ordinary craniectomy group, it was showed that patients lived in a persistent vegetative state or with severe disability were reduced and those lived with moderate disability were increased.?Conclusion?Neuroendoscopy-assisted hematoma-evacuation surgery has superior performances for hypertensive cerebral hemorrhage with concurrent cerebral herniation because of its satisfactory safety, less surgery-related injury, and reduced incidences of persistent vegetative state and severe disability.