Endoscopic Hematoma Evacuation for Intracerebral Hemorrhage Under Local Anesthesia: Factors That Affect the Hematoma Removal Rate
Endoscopic Hematoma Evacuation for Intracerebral Hemorrhage Under Local Anesthesia: Factors That Affect the Hematoma Removal Rate
复制标题
DOI：
10.1016/j.wneu.2019.03.089
复制
发表时间：
2019-06-01
影响因子：
2
通讯作者：
Tominaga, Teiji
中科院分区：
文献类型：
--
作者：
Hayashi, Toshiaki;Karibe, Hiroshi;Tominaga, Teiji
目的：内窥镜手术的最新进展使更多的患者能够接受内窥镜下清除高血压脑出血（HICH）。然而，由于微创性，通过狭窄的手术窗口进行内镜下HICH切除可能导致切除率较低。本研究的目的是探讨影响HICH清除率的因素。方法：回顾性分析28例接受内镜下血肿清除术的幕上HICH患者的资料。入选标准为自发性幕上高血压脑出血，血肿体积>30 mL，发作后24 h内入院，格拉斯哥昏迷评分≥ 4分。结果：28例患者中，女性9例，男性19例，年龄41 ~ 86岁（平均60.7 ± 12.7）。血肿部位为基底节区25例，皮质下3例。平均术前血肿体积为62.4 ± 22.5 mL。17例患者的血肿清除率≥ 60%（良好清除组）。两组比较，慢性肾功能衰竭血液透析治疗（P = 0.0072，卡方检验），肝硬化（P = 0.023，卡方检验）和外科医生经验，>= 10例内镜下HICH切除术（P = 0.016，卡方检验）是影响高血压脑出血清除率的显著因素。为了达到良好的切除率，外科医生应该有经验进行内窥镜手术。此外，应排除终末期慢性肾功能衰竭或肝硬化患者。
OBJECTIVE: Recent advances in endoscopic surgery have led to more patients being able to undergo endoscopic removal of hypertensive intracerebral hemorrhage (HICH). However, because of the minimal invasiveness, endoscopic HICH removal through a narrow surgical window can result in a low removal rate. The goal of the present study was to investigate the factors that affect the removal rate of HICH evacuation.METHODS: The data from 28 patients with supratentorial HICH who had undergone endoscopic hematoma evacuation were retrospectively analyzed. The inclusion criteria were spontaneous supratentorial HICH with a hematoma volume >30 mL, admission to the hospital within 24 hours of ictus, and a Glasgow coma scale score of >= 4.RESULTS: Of the 28 patients, 9 were women and 19 were men, ranging in age from 41 to 86 years (mean, 60.7 +/- 12.7). The hematoma location was the basal ganglia in 25 patients and subcortical in 3 patients. The mean preoperative hematoma volume was 62.4 +/- 22.5 mL. The hematoma removal rate was = 60% for in 17 patients (good evacuation group). Comparing the 2 groups, chronic renal failure treated with hemodialysis (P = 0.0072, chi(2) test), liver cirrhosis (P = 0.023, chi(2) test), and surgeon experience with >= 10 cases of endoscopic HICH removal (P = 0.016, chi(2) test) were significant factors related to the HICH removal rate.CONCLUSION: To achieve a good removal rate, surgeons should have experience performing the endoscopic procedure. Also, patients with end-stage chronic renal failure or liver cirrhosis should be excluded.