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[1]黄金钟,邱伟智,王佳音,等.幕上高血压脑出血不同手术方式的疗效对比分析[J].福建医科大学学报,2019,53(03):168-172.
 HUANG Jinzhong,QIU Weizhi,WANG Jiayin,et al.Comparative Analysis of the Curative Effect of Different Surgical Methods for Supratentorial Hypertensive Intracerebral Hemorrhage[J].Journal of Fujian Medical University,2019,53(03):168-172.
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《福建医科大学学报》[ISSN:1672-4194/CN:35-1192/R]

卷:
第53卷
期数:
2019年03期
页码:
168-172
栏目:
临床研究
出版日期:
2019-06-30

文章信息/Info

Title:
Comparative Analysis of the Curative Effect of Different Surgical Methods for Supratentorial Hypertensive Intracerebral Hemorrhage
文章编号:
1672-4194(2019)03-0168-05
作者:
黄金钟 邱伟智 王佳音 骆良钦 李亚松 高宏志
福建医科大学 附属第二医院神经外科,泉州 362000
Author(s):
HUANG Jinzhong QIU Weizhi WANG Jiayin LUO Liangqin LI Yasong GAO Hongzhi
Department of Neurosurgery, The Second Affiliated Hospital of FujianMedical University, Quanzhou 362000,China
关键词:
颅内出血 高血压性 神经内窥镜检查 外科手术 微创性 穿刺术 引流术 颅骨切开术 血肿
Keywords:
intracranial hemorrhage hypertensive neuroendoscopy surgical procedures minimally invasive punctures drainage craniotomy hematoma
分类号:
R651.1; R743.34
DOI:
-
文献标志码:
A
摘要:
目的 探讨神经内镜微创手术与常规骨瓣开颅血肿清除术、血肿穿刺引流术治疗高血压脑出血疗效的区别。 方法 收集经手术治疗的幕上高血压脑出血患者90例,分为常规骨瓣开颅手术组(开颅组)、血肿穿刺引流组(穿刺组)和神经内镜手术组(内镜组),每组30例。通过手术时间、血肿清除率、术后格拉斯哥评分(GCS)、住院时间、术后并发症和术后6月改良Rankin量表(mRS)进行评分,比较3组患者的手术疗效。 结果 90例患者均接受持续随访,随访时间>6月。内镜组、穿刺组及开颅组的手术时间分别为(1.5±0.4),(0.79±0.2)及(3.75±0.61)h,3组间比较,差别有统计学意义(P<0.05); 3组的术后第1天血肿清除率分别为(87.34%±3.42%),(52.81%±6.67%)及(86.62%±4.45%),3组间比较,差别有统计学意义(P<0.05); 3组的术后第7天GCS评分分别为(2.90±1.45),(13.07±1.80)及(11.73±2.48),3组间比较,差别有统计学意义(P<0.05); 入院时血肿量>60 mL患者的6月改良mRS评分,3组分别为(4.25±0.95),(3.25±0.50)及(2.67±0.71),3组间比较,差别有统计学意义(P<0.05); 入院时GCS评分为5~8分的患者的6月改良mRS评分,3组分别为(4.50±0.54),(3.00±0.53)及(2.80±0.78),3组间比较,差别有统计学意义(P<0.05)。 结论 对于幕上高血压脑出血患者,特别是血肿量>60 mL或GCS评分为5~8的患者,神经内镜治疗相较于其他两种外科手术,可更安全、有效地清除血肿,神经功能的改善也更大。
Abstract:
Objective To investigated the value of endoscopic evacuation, stereotactic aspiration, and craniotomy of the hypertensive intracerebral hemorrhage and to determine which methods are more suitable for the patients. Methods 90 patients with supratentorial hypertensive intracerebral hemorrhage treated by surgery were enrolled and divided into craniotomy group, hematoma puncture drainage group, or neuroendoscopic surgery group, 30 patients in each group. The characteristics of all the enrolled patients at the time of admission were assimilated. Also, the therapeutic effects of the three surgical procedures were evaluated based on short-term outcomes within 30 days and long-term outcomes at 6 months after the ictus. Results All 90 patients were followed up for more than 6 months continuously. There was no significant difference in preoperative clinical data among the 3 groups(P>0.05). The operation time was(1.5±0.4)h in the endoscopic group,(0.79±0.2)h in the stereotactic aspiration group, and(3.75±0.61)h in the craniotomy group. The differences among the 3 groups were statistically significant(P<0.05). The evacuation rate of hematoma on day 1 postoperation in stereotactic aspiration group(52.81%±6.67%)was significantly less than the other 2 groups(endoscopic group: 87.34%±3.42%; craniotomy: 86.62%±4.45%, P<0.005). GCS scores on day 7 after surgery: craniotomy group(11.73±2.48), stereotactic aspiration group(13.07±1.80), endoscopic group(2.90±1.45), a significant difference was observed among 3 groups(P<0.05). For patients with large hematoma(>60 mL)or poor consciousness(GCS score 5-8), endoscopic group exhibited the lowest mRS score among the 3 groups, with statistically significant differences(P<0.05). Conclusions The endoscopic surgery may be safer and more effective with higher evacuation rate, better functional neurological outcomes, lower complication, and mortality rates. Severely affected patients with hematoma volume>60 mL or Glasgow Coma Scale score 5-8 may benefit more from endoscopic surgery than the two other surgical procedures.

参考文献/References:

[1] van Asch C J, Luitse M J, Rinkel G J, et al. Incidence,case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis[J]. Lancet Neurol, 2010,9(2):167-176.[2] Godoy D A, Pi?ero G R, Koller P, et al. Steps to consider in the approach and management of critically ill patient with spontaneous intracerebral hemorrhage[J]. World J Crit Care Med, 2015,4(3):213-229.[3] Gregson B A, Murray G D, Mitchell P M, et al. Update on the surgical trial in lobar intracerebral haemorrhage(STICH II): statistical analysis plan[J]. Trials, 2012,13:222.[4] Xu X, Zheng Y, Chen X, et al. Comparison of endoscopic evacuation,stereotactic aspiration and craniotomy for the treatment of supratentorial hypertensive intracerebral haemorrhage: study protocol for a randomized controlled trial[J]. Trials, 2017,18(1):296.[5] Arboix A, Comes E, Garcia-Eroles L, et al. Site of bleeding and early outcome in primary intracerebral hemorrhage[J]. Acta Neurologica Scandinavica, 2002,105(4):282-288.[6] Carcel C, Sato S, Zheng D, et al. Prognostic significance of hyponatremia in acute intracerebral hemorrhage: pooled analysis of the intensive blood pressure reduction in acute cerebral hemorrhage trial studies[J]. Crit Care Med, 2016,44(7):1388-1394.[7] Zheng J, Li H, Zhao H X, et al. Surgery for patients with spontaneous deep supratentorial intracerebral hemorrhage: a retrospective case-control study using propensity score matching[J]. Medicine(Baltimore), 2016,95(11):e3024.[8] Zhang H Z, Li Y P, Yan Z C, et al. Endoscopic evacuation of basal ganglia hemorrhage via keyhole approach using an adjustable cannula in comparison with craniotomy[J]. Biomed Res Int, 2014,2014:898762.[9] Rennert R C, Signorelli J W, Abraham P, et al. Minimally invasive treatment of intracerebral hemorrhage[J]. Expert Rev Neurother, 2015, 15(8): 919-933.[10] Ziai W C. Hematology and inflammatory signaling of intracerebral hemorrhage[J]. Stroke, 2013, 44(6): 74-78.[11] Patil C G, Alexander A L, Hayden Gephart M G, et al. A population-based study of inpatient outcomes after operative management of nontraumatic intracerebral hemorrhage in the United States[J]. World Neurosurg, 2012,78(6): 640-645.[12] Turrentine F E, Wang H, Simpson V B, et al. Surgical risk factors, morbidity, and mortality in elderly patients[J]. J Am Coll Surg, 2006, 203(6): 865-877.[13] Li Q, Yang C H, Xu J G, et al. Surgical treatment for large spontaneous basal ganglia hemorrhage: retrospective analysis of 253 cases[J]. Br J Neurosurg, 2013, 27(5): 617-621.[14] Beynon C, Schiebel P, B?sel J, et al. Minimally invasive endoscopic surgery for treatment of spontaneous intracerebral haematomas[J]. Neurosurg Rev, 2015, 38(3): 421-428.[15] Wang W M, Jiang C,Bai H M. New insights in minimally invasive surgery for intracerebral hemorrhage[J]. Front Neurol Neurosci, 2015,37(11):155-165.[16] Wang W H, Hung Y C, Hsu S P, et al. Endoscopic hematoma evacuation in patients with spontaneous supratentorial intracerebral hemorrhage[J]. Chin Med Assoc, 2015,78(2):101-107.

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备注/Memo

备注/Memo:
收稿日期: 2018-09-04基金项目: 泉州市科技计划项目(2016Z049)作者简介: 黄金钟,男,主任医师. Email:1909682499@qq.com
更新日期/Last Update: 2019-06-30