微球囊辅助脑造通器在神经内镜下手术治疗基底节区脑出血中的应用*

Application of sacculus-assisted cerebrum corridor creator in neuroendoscopic surgery for basal ganglia intracerebral hemorrhage*

摘要:

探讨微球囊辅助脑造通器在神经内镜下手术治疗自发性基底节区脑出血中的临床应用效果。方法?选取该院2017年8月－2018年7月收治的自发性基底节区脑出血患者97例为研究对象，随机分为治疗组和对照组。治疗组46例，行微球囊辅助脑造通器在神经内镜下清除血肿；对照组51例，行传统骨瓣（或骨窗）开颅显微镜下清除血肿。观察两组手术情况，术后随访6个月观察两组预后效果。结果?治疗组手术时间和术中失血量均明显低于对照组（P <0.05），所有患者术后1 d行常规CT检查以了解血肿清除情况。治疗组平均清除率为（90.5±5.3）%，对照组平均血肿清除率为（78.7±11.3）%，治疗组明显高于对照组（P <0.05）。所有患者术后随访6个月，以患者的日常生活能力（ADL）作为疗效评价指标。治疗组ADLⅠ级4例，Ⅱ级15例，Ⅲ级14例，Ⅳ级13例，死亡0例；对照组ADLⅠ级5例，Ⅱ级10例，Ⅲ级11例，Ⅳ级25例，死亡0例。治疗组ADL效果良好33例（Ⅰ～Ⅲ级），效果不良13例（Ⅳ～Ⅴ级）。对照组ADL效果良好26例（Ⅰ～Ⅲ级），效果不良25例（Ⅳ～Ⅴ级）；两组恢复良好率分别为71.7%（33/46）和51.0%（26/51），治疗组预后ADL优于对照组（P <0.05）。结论?神经内镜手术相比于显微镜手术治疗自发性基底节区脑出血，临床疗效显著，手术时间缩短，术中出血量减少，血肿清除率提高，再出血发生率低，并发症发生率降低，能改善患者预后，安全性较高。微球囊辅助脑造通器提高了神经内镜手术的可视性及安全性，在保证降低手术人为创伤的条件下，达到了微侵袭神经外科所要求的以最小创伤取得最佳手术效果的目的，进一步扩大了神经内镜在神经外科领域的应用范围，具有较高的临床应用价值。

Abstract:

To investigate the clinical effect of using sacculus-assisted cerebrum corridor creator in neuroendoscopic surgery for spontaneous basal ganglia hemorrhage. Methods 97 cases who were clinically diagnosed as spontaneous basal ganglia hemorrhage from August 2017 to July 2018 were randomly divided into two groups. In treatment group, 46 patients were given neuroendoscopic surgery using sacculus-assisted cerebrum corridor creator. And 51 patients underwent craniotomy with large bone flap (or small bone window) as the control group. Observe and compare the operation results of the patients between the two groups. All the postoperative patients were followed up for 6 months to observe the prognosis in both groups. Results The operative time and intraoperative blood loss in treatment group were significantly lower than those in control group (P < 0.05). All of the preoperative patients underwent routine CT scanning at the first day after operation. The average clearance rate in the treatment group (90.5 ± 5.3)% was significantly higher than that in control group (78.7 ± 11.3)% (P < 0.05). All the patients were followed up for 6 months after operation. According to the ADL classification, in the treatment group: 4 cases of grade I, 15 cases of grade II, 14 cases of grade III, and 13 cases of grade IV; in the control group: 5 cases of grade I, 10 cases of grade II, 11 cases of grade III, and 25 cases of grade IV. There was no death case in the both groups. In the treatment group, the prognosis was good in 33 cases (in grade I ~ III), and 13 cases had poor prognosis (in grade IV ~ V). In the control group, 26 patients with good prognosis (in grade I ~ III) and 25 patients with poor prognosis (in grade I ~ III). The rates of good prognosis were 71.7% (33/46) and 51.0% (26/51), respectively. Statistical analysis of the ADL scores were performed by using the chi-square test. The prognosis of the treatment group was better than the control group (P < 0.05). Conclusion Neuroendoscopic surgery is more effective than microscopic surgery in the treatment of spontaneous basal ganglia hemorrhage. Neuroendoscopic surgery for basal ganglia cerebral hemorrhage have short operation time, less bleeding, increased hematoma clearance, reduced risk of rebleeding. The incidence of complications is reduced, the prognosis of patients is improved, and the security is higher. Application of sacculus-assisted cerebrum corridor creator in neuroendoscopic surgery improves the visibility and safety. Under condition of reducing surgical trauma, it can satisfy the requirement of minimal invasive neurosurgery in minimal trauma to achieve the best surgical effect. It further enlarges the application scope of neuroendoscopy in the field of neurosurgery, and has a high clinical application and popularization value.