神经内镜在脑血肿清除中的应用选择及优势分析

Analysis of the Application Selection and Advantages of Neuroendoscopy in the Clearance of Intracerebral Hemorrhage

摘要: 目的：通过回顾和总结临床中选择微骨窗神经内镜清除血肿的脑出血病例，并与选择开颅血肿清除术的病例进行比较，分析神经内镜下脑血肿清除术在临床中的应用优势。方法：采用回顾性研究，分析苏州大学附属第一医院2022年10月至2024年10月共80例脑出血患者的临床资料、手术过程、术后预后情况，将其分为观察组(n = 40例)和对照组(n = 40例)，观察组实施微骨窗神经内镜脑血肿清除术，对照组采用传统开颅脑血肿清除术。比较两种术式的差异。选择2例临床中具备代表性的神经内镜脑血肿清除术的病例，展示该术式的优势。结果：纳入本次研究的患者共计80位，男性42位，女性38位，平均年龄50.2 ± 10.8岁。在年龄、性别、出血部位等基线资料上两组不具备显著性差异。观察组在手术耗时、骨窗大小、术中出血量、术后住院时间、术后并发症发生率均低于对照组(p < 0.05)，在血肿清除率、术后GCS评分及术后6月GOS评分均优于对照组(p < 0.05)。两组患者的术前GCS评分差异不具备统计学意义(p > 0.05)。结论：微骨窗神经内镜清除血肿治疗脑出血，是一种安全、高效、精确的微创术式，对于特定类型的脑出血患者明显改善其预后，值得推广。

Abstract: Objective: Through a review and synthesis of clinical cases involving the treatment of intracerebral hemorrhage with minimally invasive neuroendoscopic hematoma removal, and a comparative analysis with cases treated using traditional craniotomy for hematoma evacuation, the application advantages of neuroendoscopic hematoma removal in clinical practice are examined. Method: This study employed a retrospective approach to analyze the clinical data, surgical procedures, and postoperative outcomes of 80 patients with intracerebral hemorrhage treated at the Affiliated First Hospital of Soochow University from October 2022 to October 2024. These patients were divided into an observation group (n = 40) and a control group (n = 40). The observation group underwent minimally invasive neuroendoscopic hematoma removal via a small bone window, while the control group received traditional craniotomy for hematoma evacuation. The study aimed to compare the differences between these two surgical approaches. Two representative cases of neuroendoscopic hematoma evacuation from clinical practice are selected to demonstrate the advantages of this surgical approach. Result: A total of 80 patients were included in this study, comprising 42 males and 38 females with a mean age of 50.2 ± 10.8 years. There were no significant differences between the two groups in baseline characteristics such as age, gender, and site of hemorrhage. In the observation group, parameters such as operative time, bone flap size, intraoperative blood loss, postoperative hospital stay, and postoperative complication rates were all lower than those in the control group (p < 0.05). Additionally, the observation group exhibited superior outcomes in terms of hematoma removal rate, postoperative GCS score, and GOS score at six months postoperatively (p < 0.05). Notably, there was no statistically significant difference in preoperative GCS scores between the two groups (p > 0.05). Conclusion: Micro bone window neuroendoscopic removal of hematoma for cerebral hemorrhage is a safe, efficient and precise minimally invasive surgery, which significantly improves the prognosis of patients with specific subtypes of intracerebral hemorrhage. It merits broader clinical application.