【摘要】 目的 回顾性对比机器人立体定向导向针联合内镜套筒导入神经内镜技术（观察组）与传统神经内镜技术（对照组），在治疗自发性幕上型脑出血的临床疗效及安全性。方法 纳入2021年8月至2024年10月在延安大学附属医院神经外科符合标准的患者，采用1∶1倾向得分匹配（PSM）来平衡基线偏倚，以年龄、性别、入院时血肿量、格拉斯哥昏迷量表（GCS）评分等为协变量，最终匹配观察组64例、对照组64例。比较两组术后24 h血肿清除率（主要终点）、围手术期指标、术后3个月改良Rankin量表（mRS）评分、并发症发生率及炎症与修复指标（肿瘤坏死因子-α、基质金属蛋白酶-9、脑源性神经营养因子），并采用盲法评估结局以控制主观偏倚。结果 匹配后两组基线资料均衡可比（所有协变量SMD<0.1,P>0.05）。观察组术后24 h血肿清除率高于对照组[（93.30±6.20）%vs(90.60±8.12)%,P=0.024]；术中出血量低于对照组[（55.00±5.50）mL vs(60.00±6.38)mL,P<0.001]，手术时间长于对照组[（156.00±19.43）min vs(148.00±14.71)min,P=0.012]，住院时间短于对照组[（14.00±5.20）d vs(18.00±4.40)d,P<0.001]。术后3个月，观察组mRS 0～2分比例高于对照组[62.50%(40/64)vs 43.75%(28/64),P=0.033]；观察组总并发症发生率低于对照组[7.81%(5/64)比18.75%(12/64),P<0.05]，单项并发症仅作描述性分析。术后72 h，观察组的肿瘤坏死因子-α(TNF-α)、基质金属蛋白酶-9(MMP-9)水平低于对照组（P<0.001），脑源性神经营养因子（BDNF）水平高于对照组（P<0.001）。结论 机器人立体定向导向针联合内镜套筒导入神经内镜技术治疗自发性幕上型脑出血，较传统技术能进一步提高血肿清除率，减少术中出血及术后并发症，改善神经功能预后与炎症修复状态，具有临床推广价值。更多还原

【Abstract】 Objective This retrospective study compared the clinical efficacy and safety of robotic stereotactic guiding needle combined with endoscopic sleeve-assisted neuroendoscopy(observation group) with those of conventional neuroendoscopy(control group) in the treatment of spontaneous supratentorial intracerebral hemorrhage. Methods Patients with spontaneous supratentorial basal ganglia hemorrhage admitted to the Department of Neurosurgery, Affiliated Hospital of Yan’an University, from August 2021 to October 2024 were enrolled. A 1:1 propensity score matching method was used to balance baseline differences between the two groups, with age, sex, hematoma volume on admission, and Glasgow Coma Scale score on admission included as covariates. Finally, 64 patients were matched in the observation group and 64 patients in the control group. Hematoma clearance rate at 24 h after surgery, perioperative indicators, modified Rankin Scale score at 3 months after surgery, complication rate, and inflammatory and neural repair-related markers, including tumor necrosis factor-α, matrix metalloproteinase-9 and brain-derived neurotrophic factor, were compared between the two groups. Blinded outcome assessment was performed to reduce subjective bias. Results After matching, the baseline characteristics were generally comparable between the two groups(SMD<0.1, P>0.05). The hematoma clearance rate at 24 h after surgery was higher in the observation group than in the control group [(93.30±6.20)% vs(90.60±8.12)%, P=0.024]. Intraoperative blood loss was lower in the observation group than in the control group [(55.00±5.50) mL vs.(60.00±6.38) mL, P<0.001], whereas the operation time was longer in the observation group [(156.00±19.43) min vs.(148.00±14.71) min, P=0.012]. The length of hospital stay was shorter in the observation group [(14.00±5.20) d vs.(18.00±4.40) d, P<0.001]. At 3 months after surgery, the proportion of patients with a modified Rankin Scale score of 0–2 was higher in the observation group than in the control group [62.50%(40/64) vs. 43.75%(28/64), P=0.033]. The total complication rate was lower in the observation group than in the control group [7.81%(5/64) vs. 18.75%(12/64), P<0.05]. Because of the small number of individual complications, the results of subgroup comparisons should be interpreted cautiously. At 72 h after surgery, the levels of tumor necrosis factor-α and matrix metalloproteinase-9 were lower, whereas the level of brain-derived neurotrophic factor was higher in the observation group than in the control group, with statistically significant differences(all P<0.001). Conclusion Compared with conventional neuroendoscopy, robotic stereotactic guiding needle combined with endoscopic sleeve-assisted neuroendoscopy can further improve hematoma clearance, reduce intraoperative blood loss and postoperative complications, and improve neurological outcomes as well as inflammatory and neural repair status in the treatment of spontaneous supratentorial intracerebral hemorrhage, suggesting its potential value for clinical application.更多还原