CAJ | 학술논문

目的：采用透明导管鞘辅助神经内镜治疗高血压脑出血，与传统开颅术清除血肿作比较，探讨两者的优劣与特点。方法40例高血压幕上脑出血患者随机分为透明导管鞘辅助神经内镜下颅内血肿清除组与开颅血肿清除术组，比较2组切口长度、骨窗大小、手术时间、术中出血量、术后血肿清除率、术后6个月GOS等临床资料。结果神经内镜组手术时间平均（76.1±15.5）min ，开颅组为（191.5±28.1）min（P＜0.05）；神经内镜组术出血量平均（52.0±11.3）mL ，开颅组为（455±127.9）mL（P＜0.05）；神经内镜组血肿清除率平均（87.3±6.0）％，开颅组平均（89±21.5）％（P＞0.05）；随访6个月神经内镜组恢复良好6例，轻度残疾6例，重度残疾4例，植物状态2例。开颅组恢复良好4例，轻度残疾4例，重度残疾4例，植物状态2例，死亡2例。神经内镜组患者与开颅组无明显统计学差异（ P＞0.05）。结论透明导管鞘辅助神经内镜治疗高血压脑出血，手术创伤小、时间短、并发症少、恢复快，能很大程度降低病死率、致残率，效果良好，值得临床推广应用。
목적：채용투명도관초보조신경내경치료고혈압뇌출혈，여전통개로술청제혈종작비교，탐토량자적우렬여특점。방법40례고혈압막상뇌출혈환자수궤분위투명도관초보조신경내경하로내혈종청제조여개로혈종청제술조，비교2조절구장도、골창대소、수술시간、술중출혈량、술후혈종청제솔、술후6개월GOS등림상자료。결과신경내경조수술시간평균（76.1±15.5）min ，개로조위（191.5±28.1）min（P＜0.05）；신경내경조술출혈량평균（52.0±11.3）mL ，개로조위（455±127.9）mL（P＜0.05）；신경내경조혈종청제솔평균（87.3±6.0）％，개로조평균（89±21.5）％（P＞0.05）；수방6개월신경내경조회복량호6례，경도잔질6례，중도잔질4례，식물상태2례。개로조회복량호4례，경도잔질4례，중도잔질4례，식물상태2례，사망2례。신경내경조환자여개로조무명현통계학차이（ P＞0.05）。결론투명도관초보조신경내경치료고혈압뇌출혈，수술창상소、시간단、병발증소、회복쾌，능흔대정도강저병사솔、치잔솔，효과량호，치득림상추엄응용。
Objective To compare endoscopic surgery in intracranial hematoma with transparent sheaths with traditional craniotomy to remove the hematoma ,and explore the advantages and disadvantages ,as well as characteristic.Methods 40 cases of hypertensive cerebral hemorrhage ,bleeding site located on the tentorium of cerebellum ,but not cerebral herniation.They were randomly divided into 2 groups ,endoscopic surgery in intracranial hematoma with transparent sheaths and craniotomy group;the incision length ,bone window size ,operative time ,blood loss ,rates of hematoma evacuation ,GOS after 6 months and other clinical data were compared.SPSS13.0 analysis was used to make a comparison.Results Operative time of endoscopy group (76.1 ± 15.5)min was shorter than(191.5 ± 28.1)min of craniotomy group(P<0.05).Blood loss of endoscopy group (52.0 ± 11.3)mL was much less than(455 ± 127.9)mL of craniotomy group(P<0.05).Rates of hematoma evacuation had no signifi‐cant difference:endoscopy group was (87.3 ± 6.0)% ,craniotomy group was(89 ± 21.5)% (P>0.05) ,with 6‐month follow‐up , 6 cases with endoscopy group good recovery ,6 cases with mild disability ,4 cases of severe disability ,2 cases with vegetative state.In craniotomy group ,4 cases with good recovery ,4 cases with mild disabilities ,4 cases with severe disability ,2 cases with vegetative state and 2 cases died ,which had no significant difference(P>0.05).Conclusion Endoscopic surgery in intracranial hematoma with transparent sheaths is a new form of intracranial hematoma surgery ,with the advantages of less trauma ,short operative time ,few complications ,quick recovery ,and can greatly reduce mortality and morbidity ,and has a good effect.As a new and improved way ,it is worthy of clinical application.