导航下神经内镜与显微手术治疗基底节脑出血的对比研究

Comparative study of neuroendoscopy under navigation and microsurgery for basal ganglia cerebral hemorrhage

摘要:

目的 探讨导航下神经内镜与显微手术治疗基底节脑出血的疗效及安全性。方法 将60例高血压基底节脑出血患者分为导航内镜组（n = 32）和显微手术组（n = 28），比较两组患者的临床资料。结果 导航内镜组手术时间（112.1±14.5）min，术中中位失血量100.0（92.5，140.0）mL，血肿清除率（93.6±3.7）%，术后24 h中位格拉斯哥昏迷评分（GCS）为9.0（8.0，12.0）分，较术前的9.0（8.0，11.8）分明显升高（Z = -3.50，P = 0.000），血肿周围水肿体积（14.9±5.2）mL，无术后再出血患者，ICU中位入住时间0.0（0.0，0.0）d，ICU入住率15.6%，住院时间（12.4±2.5）d，气管切开率6.3%，肺部感染率9.4%，术后6个月格拉斯哥预后评分（GOS）中位数为4.0（4.0，5.0）分，与显微手术组比较，上述指标差异均有统计学意义（P < 0.05）。结论 导航下神经内镜基底节血肿清除术可明显缩短手术时间、提高血肿清除率、减少术中术后出血、防止正常脑组织损伤、降低并发症发生率、缩短ICU入住时间和住院时间，并改善高血压脑出血患者预后。

Abstract:

Objective To explore the efficacy and safety of neuroendoscopy under navigation and microsurgery for basal ganglia cerebral hemorrhage.Methods 60 patients with hypertensive intracerebral hemorrhage in basal ganglia were divided into the group of neuroendoscopy under navigation (n = 32) and microsurgery group (n = 28), the clinical data of the two groups were compared.Results The operation time was (112.1 ± 14.5) min, the median intraoperative blood loss was 100.0 (92.5, 140.0) mL, the clearance rate of hematoma was (93.6 ± 3.7)%, the median 24 h GCS after operation was 9.0 (8.0, 12.0), which was significantly higher than that before operation (Z = -3.50, P = 0.000), the volume of edema around the hematoma was (14.9 ± 5.2) mL, and there was no re-bleeding after operation, the median time of ICU stay was 0.0 (0.0, 0.0) d, the ICU admission rate was 15.6%, the hospital stay was (12.4 ± 2.5) d, the tracheotomy rate was 6.3%, the pulmonary infection rate was 9.4%, and the median Glasgow outcome score (GOS) of 6 months after operation was 4.0 (4.0, 5.0) in the group of neuroendoscopy under navigation, compared with the microsurgery group, the above indexes were significantly different (P < 0.05).Conclusion The neuroendoscopy under navigation can significantly shorten the operation time, improve the hematoma removal rate, reduce intraoperative and postoperative hemorrhage, reduce the normal brain tissue damage, reduce incidence of complications, shorten the length and rate of in ICU and hospitalization time, and improve the prognosis of hypertensive cerebral hemorrhage.