经额平行纤维束入路神经内镜辅助颅内血肿清除术治疗高血压脑出血的疗效观察

Efficacy of endoscopic surgery of intracranial hematoma through frontal parallel fiber bundle approach in the treatment of hypertensive cerebral hemorrhage

摘要:

目的 探讨经额平行纤维束入路神经内镜技术在高血压脑出血（HCH）颅内血肿清除术中的应用效果。方法 选取2020年9月－2024年9月于该院就诊的HCH患者100例，按不同手术方法，将患者分为研究组（经额平行纤维束入路神经内镜辅助颅内血肿清除术，48例）和对照组（传统开颅血肿清除术，52例）。比较两组患者手术相关指标、炎症指标、神经功能［美国国立卫生研究院卒中量表（NIHSS）评分］、改良巴塞尔指数（MBI）、术后并发症和纤维束保护情况。结果 与对照组比较，研究组手术时间更短，术中出血量更少，差异均有统计学意义（P < 0.05）；两组患者血肿清除率和残余血肿量比较，差异均无统计学意义（P > 0.05）；术后14和28 d，研究组白细胞介素-6（IL-6）和C反应蛋白（CRP）明显低于对照组，差异均有统计学意义（P < 0.05）；与对照组比较，研究组术后3个月的NIHSS评分更低，MBI更高，差异均有统计学意义（P < 0.05）；两组患者术后并发症及并发症总发生率比较，差异均无统计学意义（P > 0.05）；研究组术后纤维束保护率为75.00%，明显高于对照组的17.31%，差异有统计学意义（P < 0.05）。结论 经额平行纤维束入路神经内镜辅助颅内血肿清除术治疗HCH的疗效确切，能减少术中出血，抑制术后炎症，保护患者脑纤维束，改善神经功能，提高日常生活能力，值得临床推广应用。

Abstract:

Objective To investigate the application effect of endoscopic surgery of intracranial hematoma through frontal parallel fiber bundle approach in hypertensive cerebral hemorrhage (HCH).Methods 100 patients with HCH from September 2020 to September 2024 were selected and divided into the study group (transfrontal parallel fiber bundle approach neuroendoscopic-assisted intracranial hematoma evacuation, 48 cases) and control group (traditional craniotomy hematoma evacuation, 52 cases) according to different surgical methods. The surgical-related indicators, inflammatory indicators, neurological function [national institute of health stroke scale (NIHSS) score], modified barthel index (MBI), postoperative complications and fiber bundle protection of the two groups of patients were compared.Results Compared with the control group, the study group had a shorter operation time and less intraoperative blood loss, and the differences were statistically significant (P < 0.05). There was no statistically significant difference in the hematoma clearance rate and residual hematoma volume between the two groups (P > 0.05). At 14 and 28 d after the operation, interleukin-6 (IL-6) and C-reactive protein (CRP) in the study group were significantly lower than those in the control group, and the differences were statistically significant (P < 0.05). Compared with the control group, the NIHSS score of the study group was lower and the MBI was higher 3 months after the operation, and the differences were statistically significant (P < 0.05). There was no statistically significant difference in postoperative complications and total complications rate between the two groups of patients (P > 0.05). The postoperative fiber bundle protection rate in the study group was 75.00%, significantly higher than 17.31% in the control group, and the difference was statistically significant (P < 0.05).Conclusion The efficacy of transfrontal parallel fiber bundle approach neuroendoscopic-assisted intracranial hematoma evacuation in the treatment of HCH is definite. It can reduce intraoperative bleeding, inhibit postoperative inflammation, protect the brain fiber bundle of patients, improve neurological function, and enhance the ability of daily living. It is worthy of clinical promotion and application.