透明通道辅助硬镜治疗脑室出血铸型的临床研究*

Clinical investigation on the therapeutic effect of transparent channel assisted neuroendoscope on intraventricular hemorrhage casting*

摘要:

摘要：目的??探讨采用透明通道辅助神经内镜治疗脑室出血铸型的方法及疗效。方法 回顾性分析2015年1月－2018年6月该科收治的脑室出血铸型患者42例，其中内镜手术组（A组）19例，双侧脑室穿刺外引流+尿激酶治疗组（B组）23例。术前排除动脉瘤、动静脉畸形等。比较两组术后1?d、3?d和1周的血肿残留率、格拉斯哥昏迷评分（GCS）、引流管拔管时间、术后并发症发生率（再出血、颅内感染、脑积水和应激性溃疡出血）和3个月格拉斯哥昏迷预后评分（GOS）。结果 A组术后血肿残留率及GCS评分改善明显优于B组，A组拔管时间早于B组，脑积水发生率、应激性溃疡发生率低于B组，两组再出血、颅内感染发生率相当。A组GOS评分整体预后优于B组，A组死亡率低于B组。结论 内镜微创清除脑室出血铸型能降低死亡率，减少并发症，改善预后。

Abstract:

Abstract: Objective?To explore the method and clinical effect of ventriculoscopic surgery assisted by transparent channel on intraventricular hemorrhage casting.?Methods?42 patients with intraventricular hemorrhage casting were analyzed retrospectively, with the etiology exclusion for rupture of aneurysmal, arteriovenous malformation, etc. Among them, 19 cases treated with ventriculoscope-assisted surgery (A group), other 23 cases received bilateral external ventricular drainage combined with urokinase intraventricular injection (B group). The hematoma residual, Glasgow coma scale (GCS) score, extubation time, and postoperative complications such as rehaemorrhagia, intracranial infection, hydrocephalus and stress ulcer were compared between these two groups at 1 day, 3 day, and 7 day after operation. GOS score followed up for 3 months were also brought into.?Results?The postoperative hematoma residual in A group was less than that in B group, the improvement of GCS score was more obvious in A group, caused a decrease in extubation time and incidence of postoperative complications such as hydrocephalus and stress ulcer, while for other postoperative complications such as rehaemorrhagia and intracranial infection, the incidence between the two groups had no statistical difference. The prognosis for patients in A group was better than that in B group and the mortality was decreased.?Conclusion?As an effective surgical procedure for intraventricular hemorrhage casting, ventriculoscope-assisted surgery can reduce mortality, complications and therefore improve the prognosis.