目的:本研究旨在评估神经内镜治疗高血压壳核出血(HPH)的疗效和安全性。与传统开颅手术相比。
方法:我们回顾性分析了2015年1月至2017年12月在安徽医科大学附属安徽省立医院神经外科接受神经内镜(n=36)或开颅手术(n=45)治疗的81例HPH患者。我们比较了临床和影像学结果,排除14例未符合纳入标准的患者.记录急诊室的患者特征。此外,住院天数,住院期间的总费用,手术时间,失血,疏散率,再繁殖,颅内感染,肺部感染,癫痫,消化道出血,静脉血栓,低蛋白血症,失语症,动眼神经麻痹,死亡率,术后6个月改良Rankin量表评分,比较两组患者术后6个月的Glasgow预后量表评分。
结果:术前患者资料的对比分析显示无明显差异。神经内镜手术提供了明显的好处,包括减少手术时间,患者失血最少,并增强血肿清除的疗效。然而,术后并发症如再出血的发生率,颅内感染,肺部感染,术后癫痫,消化道出血,静脉血栓,低蛋白血症,失语症,和动眼神经麻痹没有显着差异。相比之下,内窥镜技术,相对于传统的开颅血肿清除术,其特点是侵入性较小的切口,住院时间明显减少,以及相关医疗成本的大幅降低。此外,内镜技术有助于患者的长期康复效果,而不改变死亡率。
结论:与常规开颅手术相比,利用神经内镜治疗高血压壳核出血(HPH),微创,和具有成本效益的方法。这种替代方法有可能缩短住院时间并改善长期神经系统预后。而不改变死亡率。
OBJECTIVE: This study aimed to evaluate the efficacy and safety of
neuroendoscopy for treating hypertensive putamen hemorrhage (HPH), compared with traditional craniotomy.
METHODS: We retrospectively analyzed 81 consecutive patients with HPH treated with
neuroendoscopy (n=36) or craniotomy (n=45) in the Department of Neurosurgery at the Anhui Provincial Hospital Affiliated to Anhui Medical University between January 2015 and December 2017. We compared the clinical and radiographic outcomes, excluded 14 patients who did not meet the inclusion criteria. Patient characteristics in emergency room were recorded. In addition, hospitalization days, total cost during hospitalization, operative time, blood loss, evacuation rate, rebreeding, intracranial infection, pulmonary infection, epilepsy, hemorrhage of digestive tract, venous thrombus, hypoproteinemia, aphasia, oculomotor paralysis, mortality, Modified Rankin Scale score 6 months after surgery, and Glasgow Outcome Scale score 6 months after surgery were compared between the 2 groups.
RESULTS: Comparative analysis of preoperative patient data revealed no notable disparities. Neuroendoscopic surgery afford distinct benefits including reduced operative time, minimal patient blood loss, and enhanced efficacy in hematoma evacuation. However, the incidence of postoperative complications such as rebleeding, intracranial infections, pulmonary infections, postoperative epilepsy, hemorrhage of digestive tract, venous thrombus, hypoproteinemia, aphasia, and oculomotor paralysis did not significantly differ. In contrast, endoscopic techniques, relative to conventional craniotomy for hematoma evacuation, are characterized by less invasive incisions, a marked decrease in the duration of hospitalization, and a substantial reduction in associated healthcare costs. Furthermore, endoscopic techniques contribute to superior long-term recuperative outcomes in patients, without altering mortality rates.
CONCLUSIONS: In comparison to the conventional method of craniotomy, the utilization of
neuroendoscopy in the treatment of hypertensive putamen hemorrhage (HPH) may offer a more efficacious, minimally invasive, and cost-effective approach. This alternative approach has the potential to decrease the length of hospital stays and improve long-term neurologic outcomes, without altering mortality rates.