神经内镜硬通道技术在高血压脑出血诊治中的临床疗效

Clinical Efficacy of Neuroendoscopy with Hard Channel Technique in the Diagnosis and Treatment of Hypertensive Intracerebral Hemorrhage

摘要: 目的：研究神经内镜联合硬通道技术在颅内血肿清除手术中相较于传统开颅显微镜手术的优势，同时探讨神经内镜对于治疗颅内深部血肿的临床疗效。方法：从2017年3月至2021年6月进行的手术自发性脑出血患者中选取117名研究对象进行回顾性分析，比较神经内镜与传统开颅手术在血肿清除率、手术时间及预后等方面的差异。结果：神经内镜联合硬通道技术在血肿清除率方面优于传统开颅显微镜手术[(94.7 ± 4.8)% vs. (87.8 ± 11.4)%, P = 0.012]。尤其适用于颅内深部血肿，即基底节区脑出血，伴或不伴有脑室内血肿[(94.8 ± 4.6)% vs. (86.8 ± 13.0)%, P = 0.026]。神经内镜手术时间明显短于传统开颅手术时间[(2.2 ± 0.5)% vs. (4.4 ± 1.1)%, P < 0.05]。通过定期随访患者，我们得出格拉斯哥预后评分(GOS评分)，神经内镜组患者的远期预后往往好于传统开颅显微镜手术组[(4.05 ± 0.65)% vs. (3.41 ± 1.27)%, P = 0.041]。结论：神经内镜联合硬通道技术相较于传统开颅显微镜手术，手术时间短、血肿清除率高、预后较好，是相对安全且有效的微侵袭手术方式之一。

Abstract: Objective: To investigate the advantages of neuroendoscopy with hard channel technique in the removal of intracranial hematoma compared with traditional craniotomy microscope surgery and probe into the clinical efficacy of neuroendoscopy in the treatment of deep intracranial hematoma. Methods: A total of 117 study subjects selected from patients with the surgery of spontaneous intracerebral hemorrhage performed from March 2017 to June 2021 were retrospectively analyzed to compare the differences in hematoma clearance, operation time and prognosis between neuroendoscopy and traditional craniotomy. Results: Neuroendoscopy with hard channel technique was significantly better than traditional craniotomy microscope surgery in hematoma clearance rate [(94.7 ± 4.8)% vs. (87.8 ± 11.4)%, P = 0.012]. It was especially suitable for deep intracranial hematoma, i.e. cerebral hemorrhage in the basal ganglia region, with or without intraventricular hematoma [(94.8 ± 4.6)% vs. (86.8 ± 13.0)%, P = 0.026]. The time of neuroendoscopic surgery was significantly shorter than that of craniotomy [(2.2 ± 0.5)% vs. (4.4 ± 1.1)%, P < 0.05]. By following up the patients regularly, we derived a Glasgow Outcome Scale (GOS score), and the long-term prognosis of patients in neuroendoscopy group tended to be better than that of traditional craniotomy microscope surgery group [(4.05 ± 0.65)% vs. (3.41 ± 1.27)%, P = 0.041]. Conclusion: Compared with traditional craniotomy microscope surgery, neuroendoscopy with hard channel technique is one of the relatively safe and effective minimally invasive surgery methods with shorter operative time, higher hematoma clearance rate, and better prognosis.