Effectiveness of endoscopic surgery for supratentorial hypertensive intracerebral hemorrhage: a comparison with craniotomy
Effectiveness of endoscopic surgery for supratentorial hypertensive intracerebral hemorrhage: a comparison with craniotomy
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内镜手术治疗幕上高血压脑出血的疗效：与开颅手术的比较
DOI：
10.3171/2016.10.jns161589
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发表时间：
2018-02-01
影响因子：
4.1
通讯作者：
Xu, Bainan
中科院分区：
文献类型：
--
作者：
Xu, Xinghua;Chen, Xiaolei;Xu, Bainan
目的探讨鼻内窥镜手术治疗幕上高血压性脑出血(HICH)的有效性和实用性。方法回顾分析解放军总医院神经外科2009年1月至2014年6月收治的151例幕上高血压性脑出血患者的临床资料。根据他们接受的手术，患者被分为内窥镜检查组(82例)和开颅手术组(69例)。用3D Slicer软件测量血肿体积，计算血肿清除率。比较两组患者的手术时间、术中出血量、术后1周格拉斯哥昏迷评分、住院时间、术后6个月改良Rankin评分。结果两组患者术前比较差异无统计学意义(p>；0.05)。两组血肿清除率分别为90.5%+/-6.5%和82.3%+/-8.6%，差异有统计学意义(P<；0.01)。内窥镜组手术时间为1.6±0.7小时，开颅手术组为5.2±1.8小时(P<；0.01)。术中出血量内窥镜组为91.41±93.1ml，开颅组为605.6±602.3 ml(p<0.01)。术后1周格拉斯哥昏迷评分内窥镜组为11.5+/-2.9，开颅组为8.3+/-3.8(p<；0.01)。内窥镜组住院天数为11.6±6.9天，开颅组为13.2±7.9天(P<；0.05)。术后6个月，内窥镜组平均改良Rankin评分为3.2+/-1.5，开颅组为4.1+/-1.9(p<；0.01)。内窥镜组患者的恢复情况好于开颅手术组。数据以平均+/-SD表示。结论与传统开颅手术相比，内窥镜手术更有效，侵袭性更小，可能改善了幕上脑出血患者的预后。内窥镜手术是治疗幕上脑出血的一种很有前途的方法。随着内窥镜技术的发展，内窥镜排空术将在临床上得到更广泛的应用。需要进行前瞻性随机对照试验。
OBJECTIVE The goal of this study was to investigate the effectiveness and practicality of endoscopic surgery for treatment of supratentorial hypertensive intracerebral hemorrhage (HICH) compared with traditional craniotomy.METHODS The authors retrospectively analyzed 151 consecutive patients who were operated on for treatment of supratentorial HICH between January 2009 and June 2014 in the Department of Neurosurgery at Chinese PLA General Hospital. Patients were separated into an endoscopy group (82 cases) and a craniotomy group (69 cases), depending on the surgery they received. The hematoma evacuation rate was calculated using 3D Slicer software to measure the hematoma volume. Comparisons of operative time, intraoperative blood loss, Glasgow Coma Scale score 1 week after surgery, hospitalization time, and modified Rankin Scale score 6 months after surgery were also made between these groups.RESULTS There was no statistically significant difference in preoperative data between the endoscopy group and the craniotomy group (p > 0.05). The hematoma evacuation rate was 90.5% +/- 6.5% in the endoscopy group and 82.3% +/- 8.6% in the craniotomy group, which was statistically significant (p < 0.01). The operative time was 1.6 +/- 0.7 hours in the endoscopy group and 5.2 +/- 1.8 hours in the craniotomy group (p < 0.01). The intraoperative blood loss was 91.4 +/- 93.1 ml in the endoscopy group and 605.6 +/- 602.3 ml in the craniotomy group (p < 0.01). The 1-week postoperative Glasgow Coma Scale score was 11.5 +/- 2.9 in the endoscopy group and 8.3 +/- 3.8 in the craniotomy group (p < 0.01). The hospital stay was 11.6 +/- 6.9 days in the endoscopy group and 13.2 +/- 7.9 days in the craniotomy group (p < 0.05). The mean modified Rankin Scale score 6 months after surgery was 3.2 +/- 1.5 in the endoscopy group and 4.1 +/- 1.9 in the craniotomy group (p < 0.01). Patients had better recovery in the endoscopy group than in the craniotomy group. Data are expressed as the mean +/- SD.CONCLUSIONS Compared with traditional craniotomy, endoscopic surgery was more effective, less invasive, and may have improved the prognoses of patients with supratentorial HICH. Endoscopic surgery is a promising method for treatment of supratentorial HICH. With the development of endoscope technology, endoscopic evacuation will become more widely used in the clinic. Prospective randomized controlled trials are needed.