Feng Yi, He Jianqing, Liu Bin, Yang Likun, Wang Yuhai
Anhui Medical University, School of Clinical Medicine (101-Hospital), Wuxi, China.
Turk Neurosurg. 2016;26(1):84-9. doi: 10.5137/1019-5149.JTN.12669-14.0.
Hypertensive cerebral hemorrhage (HCH) is a potentially life-threatening cerebrovascular disease with high mortality. In case of a massive hematoma, surgical drainage is a crucial treatment. The aim of the present study was to assess the efficacy of the endoscope-assisted keyhole technique in elderly patients with intracerebral hematoma who needed a flap craniotomy as traditional treatment.
One hundred-eighty-four elderly patients with HCH, who had craniotomy indications after conservative treatment for 6-24 hours after onset, were randomly divided into two groups. In the craniotomy group, traditional hematoma drainage was performed. In the keyhole group, an endoscope-assisted keyhole technique was used. Anesthesia time, blood loss, hematoma drainage rate, and complications were compared. The clinical primary outcome was the six-month efficacy rate (defined by the activities of daily living (ADL) score).
Anesthesia time was longer in the craniotomy group (3.43 ± 0.65 vs. 1.53 ± 0.52 h, P < 0.01), and blood losses were more important (256 ± 129 vs. 96 ± 39 ml P < 0.01). There was no difference in hematoma drainage rate between the two groups (77.25 ± 13.44 vs. 83.52 ± 27.51% P > 0.05). Complications, including tracheotomy (P < 0.01), pulmonary infection (P < 0.01) and hypoproteinemia (P < 0.05) were more frequent in the craniotomy group. There was no difference in the occurrence of other complications, including revision surgery digestive tract ulcer and epilepsy. Proportion of patients with good prognosis (ADL I-III) was larger in the keyhole group (P < 0.05).
In elderly HCH patients with an indication for hematoma drainage, better outcomes were achieved using an endoscope-assisted keyhole technique.
高血压性脑出血（HCH）是一种具有潜在生命威胁、死亡率高的脑血管疾病。对于大量血肿的情况，手术引流是关键治疗方法。本研究的目的是评估内镜辅助锁孔技术在需要传统开颅手术治疗的老年脑内血肿患者中的疗效。
184例HCH老年患者，发病后经6 - 24小时保守治疗有开颅指征，随机分为两组。开颅组采用传统血肿引流术。锁孔组采用内镜辅助锁孔技术。比较两组的麻醉时间、失血量、血肿引流率及并发症。临床主要结局为6个月疗效率（由日常生活活动能力（ADL）评分定义）。
开颅组麻醉时间更长（3.43±0.65 vs. 1.53±0.52小时，P<0.01），失血量更多（256±129 vs. 96±39毫升，P<0.01）。两组血肿引流率无差异（77.25±13.44 vs. 83.52±27.51%，P>0.05）。开颅组并发症更常见，包括气管切开（P<0.01）、肺部感染（P<0.01）和低蛋白血症（P<0.05）。其他并发症，包括二次手术、消化道溃疡和癫痫的发生率无差异。锁孔组预后良好（ADL I - III级）的患者比例更高（P<0.05）。
对于有血肿引流指征的老年HCH患者，采用内镜辅助锁孔技术可取得更好的疗效。
