【摘要】 目的 探究CT引导下神经内镜微创治疗在高血压出血血肿清除术的应用研究。方法 回顾性分析睢县人民医院2022年12月至2024年6月收治的高血压脑出血患者。根据手术方案不同将其分为开颅组（行标准骨窗开颅血肿清除术）与微创组（行CT引导下神经内镜微创血肿清除术），倾向性匹配排除基线资料混杂因素（卡钳值0.02），各组纳入47例基线资料差异无统计学意义的患者。对比2组患者围术期指标（手术时间、术中出血量、切口长度、血肿清除率）、术后并发症、术后1个月美国国立卫生研究院卒中量表（NIHSS）及Barthel指数评定量表（BI）、术后3个月神经系统结局[格拉斯哥预后评分（GOS）]。本文采用SPSS22.0分析。计数资料以例数（%）表示，应用χ~2检验或秩和检验；计量资料应用x±s表示，组间应用独立样本t检验，同组手术前后应用配对t检验分析，P<0.05为差异有统计学意义。结果 微创组手术时间、术中出血量、切口长度均显著低于开颅组（P<0.05），血肿清除率显著高于开颅组（P<0.05）；微创组并发症发生率4.3%显著低于开颅组17.0%，差异具有统计学意义（χ~2=4.029,P=0.045）；术后1个月微创组NIHSS评分低于开颅组（P<0.05）,BI高于开颅组（P<0.05）；微创组术后3个月神经系统结局显著优于开颅组（P<0.05）。结论CT引导下神经内镜微创血肿清除术可有效治疗高血压脑出血，手术用时、出血量更低，切口长度更小，血肿清除率更高，且能够改善患者神经功能与生活功能，疗效及安全性均优于标准骨窗开颅术，值得应用。更多还原

【Abstract】 Objective To explore the application of CT-guided neuroendoscopic minimally invasive treatment in hypertensive hemorrhage hematoma clearance surgery. Methods Patients with hypertensive cerebral hemorrhage in the Suixian People ′ s Hospital from December 2022 to June 2024 were retrospectively analyzed.According to the different surgical regimens, they were divided into craniotomy group(standard bone window craniotomy hematoma removal) and minimally invasive group(CT-guided neuroendoscopic minimally invasive hematoma removal). The propensity matching was used to exclude the confounding factors of baseline data(Caliper value 0.02), and 47 patients with no statistically significant baseline data(P>0.05) were included in each group. The perioperative indicators(surgical time, intraoperative blood loss volume, incision length, hematoma clearance rate), postoperative complications, neurological function(NIHSS) and living ability(BI) before surgery and at 1 month after surgery and neurological outcome [Glasgow outcome scale(GOS)] at 3 months after surgery were compared between groups. Thee data was analyzed using SPSS 22.0. Categorical variables are presented as frequency counts and percentages(n, %), analyzed using the χ~2 test or rank sum test as appropriate. Normally distributed continuous variables are expressed as Mean ±SD, with between-group comparisons analyzed by independent samples t-test and within-group preoperative-postoperative comparisons by paired samples t-test.Statistical significance was defined as P<0.05. Results The surgical time, intraoperative blood loss volume and incision length in minimally invasive group were significantly shorter or less than those in craniotomy group( P<0.05), and the hematoma clearance rate was significantly higher than that in craniotomy group( P<0.05). The incidence of complications in minimally invasive group(4.3%) was significantly lower than that in craniotomy group(17.0%)(χ~2=4.029, P=0.045). At 1 month after surgery, NIHSS in minimally invasive group was significantly lower(P<0.05) while BI was significantly higher than that in craniotomy group(P<0.05). The neurological outcome in minimally invasive group at 3 months after surgery was significantly better than that in craniotomy group( P<0.05). Conclusion CT-guided neuroendoscopic minimally invasive hema-toma removal can effectively treat hypertensive cerebral hemorrhage, with shorter surgical time and reduced bleed-ing volume, smaller incision length, higher hematoma removal rate, and can improve the neurological function and life function of patients. The efficacy and safety are better than those of standard bone window craniotomy.更多还原