神经内镜联合术野干燥技术快速清除铸型脑室内出血的临床研究

Clinical Study of Rapid Removal of Cast Intraventricular Hemorrhage by Neuroendoscopy Combined with Dry-Field Technique

摘要: 目的：探讨神经内镜联合术野干燥技术(dry-field technique, DFT)快速清除铸型脑室内出血的可行性及短期临床疗效。方法：回顾性收集2021年1月至2024年10月山东第一医科大学第二附属医院采用神经内镜联合DFT治疗的铸型脑室内出血患者，分析其临床资料、手术方法、围手术期指标及随访结局。结果：共纳入10例患者，均在神经内镜联合DFT下完成手术。手术时间为(149.1 ± 35.7) min，血肿清除率为(85.98 ± 7.76)%，术中失血量为100.0 (50.0, 137.5) mL。随访1~12个月，9例存活，1例死于中枢性呼吸循环衰竭；1例发生交通性脑积水并接受脑室–腹腔分流术。9例存活患者末次随访mRS评分为3.0 (3.0, 3.0)分，其中mRS 2分2例、3分5例、4分2例。未观察到术后再出血及颅内感染。结论：神经内镜联合DFT治疗铸型脑室内出血可在直视下快速清除脑室内血肿、恢复脑脊液循环并减少镜头污染。本研究初步提示该技术具有较好的安全性和可行性，后需大样本及前瞻性对照研究验证。

Abstract: Objective: To investigate the feasibility and short-term clinical efficacy of neuroendoscopy combined with the dry-field technique (DFT) for the rapid removal of cast intraventricular hemorrhage. Methods: Patients with cast intraventricular hemorrhage who underwent neuroendoscopy combined with DFT at The Second Affiliated Hospital of Shandong First Medical University between January 2021 and October 2024 were retrospectively included. Clinical characteristics, surgical procedures, perioperative parameters, and follow-up outcomes were analyzed. Results: Ten patients were included, and all procedures were completed under neuroendoscopy combined with DFT. The operative time was 149.1 ± 35.7 min, the hematoma clearance rate was 85.98% ± 7.76%, and the median intraoperative blood loss was 100.0 (50.0, 137.5) mL. During 1 - 12 months of follow-up, 9 patients survived and 1 patient died of central respiratory and circulatory failure. Communicating hydrocephalus occurred in 1 patient, who underwent ventriculoperitoneal shunting. The mRS score at the last follow-up among the 9 surviving patients was 3.0 (3.0, 3.0), with mRS 2 (n = 2), mRS 3 (n = 5), mRS 4 (n = 2). No postoperative rebleeding or intracranial infection was observed. Conclusion: Neuroendoscopy combined with DFT may allow rapid removal of cast intraventricular hematoma under direct visualization, facilitate restoration of cerebrospinal fluid circulation, and reduce lens contamination. This study preliminarily suggests that the technology demonstrates good safety and feasibility, but further validation through large-scale prospective controlled studies is required.