Endoscopy-guided removal of spontaneous intracerebral hemorrhage: comparison with computer tomography-guided stereotactic evacuation
Endoscopy-guided removal of spontaneous intracerebral hemorrhage: comparison with computer tomography-guided stereotactic evacuation
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DOI：
10.1007/s00381-007-0325-6
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发表时间：
2007-06-01
影响因子：
1.4
通讯作者：
Kirino, Takaaki
中科院分区：
文献类型：
--
作者：
Nishihara, Tetsuhiro;Morita, Akio;Kirino, Takaaki
背景和目的自发性脑出血（ICH）仍然是一个主要的医学和社会经济问题。虽然手术未能显示出对功能结果的益处，但侵入性更小、速度更快的手术减压可能会改善结果。作者介绍了内窥镜引导下的疏散治疗ICH，并报告了其优于传统方法的好处。材料与方法行内窥镜下脑出血引流术27例（E组）。将临床特征和结果与20例行计算机断层扫描（CT）引导立体定向切除脑出血（C组）的回顾性资料进行比较。置信水平小于0.05认为有统计学意义。结果两组患者除脑出血体积差异无显著性差异外，其余各方面预后均优于E组。E组患者手术时间较短（72 min vs 102 min, p < 0.01），血肿清除效果较好（95.5% vs 75%, p < 0.01），重症监护病房（ICU）住院时间较短；术后1周，E组患者的神经系统预后明显改善（p < 0.01），而C组患者无明显改善（p < 0.01）。6个月时，E组患者的格拉斯哥预后量表优于C组（p < 0.05）。9例患者（33%）术后6个月恢复良好。结论内镜下血肿清除术对脑出血有快速、充分的减压作用。结果优于ct引导下的血肿清除术。需要进一步的研究来评估这种手术对脑出血功能结果的真正益处。
Background and purpose Spontaneous intracerebral hemorrhage (ICH) continues to be a major medical and socioeconomic problem. While the surgical procedure failed to show benefits over functional outcome, a less invasive and quicker surgical decompression might improve the outcome. The authors introduced endoscopy-guided evacuation in managing ICH and reports the benefits over the conventional method.Materials and methods Twenty-seven cases underwent endoscopic evacuation of ICH (Group E). The clinical features and outcomes were compared to the retrospective data of 20 cases who underwent computer tomography (CT)-guided stereotactic removal of ICH (Group C). Confidence level less than 0.05 was considered statistically significant.Results While the clinical features of the two groups were not significantly different except for the ICH volume, outcomes were better in all aspects in Group E. The patients in Group E required shorter operative time (72 min vs 102 min, p < 0.01) with better hematoma evacuation (95.5% vs 75%, p < 0.01), shorter stay in the intensive care unit (ICU; 4.2 days vs 6.9 days, p < 0.01) and less frequent CT scanning (6.4 times vs 8.6 times, p < 0.01) compared to the patients in Group C. Neurological outcome improved significantly in Group E 1 week after surgery (p < 0.01), but not in Group C. Glasgow outcome scale at 6 months were better in Group E than in Group C (p < 0.05). Nine patients (33%) showed good recovery at 6 months postoperatively after endoscopic evacuation of ICH.Conclusion Endoscopic hematoma evacuation provided the quick, adequate decompression of ICH. The outcomes were better than the CT-guided hematoma removal. Further study is necessary to evaluate the real benefit of this surgical procedure over the functional outcome of ICH.