【摘要】 目的探讨内镜下颅内血肿清除术与开颅血肿清除术在高血压脑出血(HICH)中的治疗效果。方法回顾性分析绵阳市中心医院神经外科自2018年10月至2019年10月收治的HICH且符合纳入标准的患者共108例,根据手术方式不同分为内镜组与开颅组,每组54例。观察2组患者在手术过程中的手术时间与术中出血量,以及术后再出血、颅内感染、肺部感染等并发症情况。对比2组患者术后3周的GCS评分以及术后6个月的日常生活能力量表预后分级差异。结果内镜组患者手术时间与术中出血量均低于开颅组,差异具有统计学意义(P<0.05)。术后3周时内镜组中意识清醒及轻度意识障碍患者的数量多于开颅组,重度意识障碍及深昏迷或脑死亡的患者数量少于开颅组;且术后6个月时内镜组患者的预后良好率高于开颅组,差异具有统计学意义(P<0.05)。内镜组患者术后并发症发生率低于开颅组,差异具有统计学意义(P<0.05)。结论与传统的扩大翼点入路去大骨瓣颅内血肿清除术式相比,神经内镜技术提高减少了手术时间与术中出血量,改善了部分患者的预后,在手术治疗HICH的过程中具有更好的治疗效果。更多还原

【Abstract】 【Abctract】 Objective To discuss the therapeutic effect of endoscopic intracranial hematoma clearance and craniotomy hematoma clearance in hypertensive intracerebral hemorrhage(HICH).Methods A total of 108 patients with HICH who met the inclusion criteria in Neurosurgery Department of Mianyang Central Hospital from October 2018 to October 2019 were retrospectively analyzed, and they were divided into endoscopic group(n=54) and craniotomy group(n=54) according to different surgical methods.The operation time and intraoperative blood loss, postoperative rebleeding, intracranial infection, pulmonary infection and other complications of the two groups were observed. GCS score at 3 weeks after operation and ability of daily living score at 6 months after operation were compared between the two groups. Results The operation time and intraoperative blood loss in the endoscopic group were lower than those in the craniotomy group(P <0.05); at 3 weeks after operation, the number of patients with conscious and mild disturbance of consciousness in the endoscopic group was more than that in the craniotomy group, and the number of patients with severe disturbance of consciousness, deep coma or brain death was less than that in the craniotomy group; and the good prognosis rate of endoscopic group was higher than that of craniotomy group at 6 months after operation, the differences were statistically significant(P <0.05). The incidence of postoperative complications in endoscopic group was lower than that in craniotomy group(P <0.05).Conclusion Compared with the traditional extended pterional approach to remove intracranial hematoma with large bone flap, neuroendoscopic technique improves the operation time and blood loss, improves the prognosis of some patients, and has better therapeutic effect in the process of surgical treatment of HICH.更多还原