CAJ | 학술논문

目的：比较高血压脑出血神经内镜血肿清除与开颅手术血肿清除的疗效和预后。方法总结我院神经外科2009年6月-2013年12月收治的164例幕上高血压脑出血患者，分别采用神经内镜清除血肿(89例)和开颅手术清除血肿(75例)，比较两组患者血肿清除率、手术时间、手术失血量、术后1周格拉斯哥评分(glasgow coma scale，GCS)、住院天数和术后6个月改良Rankins(modified rankin scale，mRS)评分的差异。结果内镜组与开颅组术前资料差异无统计学意义(P均＞0.05)。血肿清除率：内镜组90.3%±5.6%，开颅组82.1%±8.3%(P＜0.01)；手术时间：内镜组(1.7±0.8) h，开颅组(5.1±1.6) h (P＜0.01)；手术失血量：内镜组(94.4±99.1) ml，开颅组(610.7±612.7) ml (P＜0.01)；术后1周GCS评分：内镜组11.6±3.3，开颅组8.4±4.5(P＜0.01)；住院时间：内镜组(11.9±7.2) d，开颅组(13.3±8.7) d (P＜0.05)；术后6个月mRS评分：内镜组3.2±1.8，开颅组4.1±1.6，内镜组患者预后显著优于开颅组患者(P＜0.01)。结论高血压脑出血神经内镜手术技术可行、微创高效，能够改善病人的手术疗效和预后。
목적：비교고혈압뇌출혈신경내경혈종청제여개로수술혈종청제적료효화예후。방법총결아원신경외과2009년6월-2013년12월수치적164례막상고혈압뇌출혈환자，분별채용신경내경청제혈종(89례)화개로수술청제혈종(75례)，비교량조환자혈종청제솔、수술시간、수술실혈량、술후1주격랍사가평분(glasgow coma scale，GCS)、주원천수화술후6개월개량Rankins(modified rankin scale，mRS)평분적차이。결과내경조여개로조술전자료차이무통계학의의(P균＞0.05)。혈종청제솔：내경조90.3%±5.6%，개로조82.1%±8.3%(P＜0.01)；수술시간：내경조(1.7±0.8) h，개로조(5.1±1.6) h (P＜0.01)；수술실혈량：내경조(94.4±99.1) ml，개로조(610.7±612.7) ml (P＜0.01)；술후1주GCS평분：내경조11.6±3.3，개로조8.4±4.5(P＜0.01)；주원시간：내경조(11.9±7.2) d，개로조(13.3±8.7) d (P＜0.05)；술후6개월mRS평분：내경조3.2±1.8，개로조4.1±1.6，내경조환자예후현저우우개로조환자(P＜0.01)。결론고혈압뇌출혈신경내경수술기술가행、미창고효，능구개선병인적수술료효화예후。
Objective To compare the effectiveness and prognosis of endoscopic evacuation with traditional craniotomy in patients with hypertensive intracerebral hemorrhage (HICH).Methods A total of 164 consecutive patients with supratentorial hypertensive intracerebral hemorrhage admitted to the department of neurosurgery in our hospital from June 2009 to December 2013 were recruited into this study, and they were divided into endoscopy group (n=89) and craniotomy group (n=75) according to the surgical method. Clinical data about these patients were collected and comparisons of clinical outcome and long-term prognosis between these 2 groups were made.Results There were no significant differences of preoperative data between these two groups (P>0.05). The evacuation rate of hematoma in endoscopy group (90.3%±5.6%) was significantly higher than that in craniotomy group (82.1%±8.3%) (P<0.01). The operation time was 1.7±0.8 h for endoscopy group and 5.1±1.6 h for craniotomy group (P<0.01). The average blood loss during operation was 94.4±99.1 ml for endoscopy group and 610.7±612.7 ml for craniotomy group (P<0.01). Mean GCS score a week after surgery was 11.6±3.3 for endoscopy group and 8.4±4.5 for craniotomy group (P<0.01). The average hospitalization time was 11.6±3.3 d for endoscopy group and 8.4±4.5 d for craniotomy group (P<0.05). The mean Modified Rankin Scales (mRS) of 6-month follow-up was 3.2±1.8 for endoscopy group and 4.1±1.6 for craniotomy group (P<0.05). Patients in endoscopy group got a better prognosis than patients in craniotomy group.Conclusion Endoscopic evacuation is a technically feasible, minimally invasive and highly efficient technique for the management of hypertensive intracerebral hemorrhage. Endoscopic surgery can improve the outcome and prognosis of patients with supratentorial hypertensive intracerebral hemorrhage.