J Neurosurg. 2018 Feb;128(2):553-559. doi: 10.3171/2016.10.JNS161589. Epub 2017 Apr 7.
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.
本研究旨在探讨内镜手术治疗幕上高血压性脑出血（HICH）的有效性和实用性，并与传统开颅手术进行比较。
回顾性分析 2009 年 1 月至 2014 年 6 月期间在解放军总医院神经外科接受手术治疗的 151 例幕上 HICH 患者。根据手术方式，将患者分为内镜组（82 例）和开颅组（69 例）。采用 3D Slicer 软件计算血肿清除率，测量血肿体积。比较两组患者的手术时间、术中出血量、术后 1 周格拉斯哥昏迷量表（GCS）评分、住院时间和术后 6 个月改良 Rankin 量表（mRS）评分。
内镜组和开颅组术前数据比较差异无统计学意义（p>0.05）。内镜组血肿清除率为 90.5%±6.5%，开颅组为 82.3%±8.6%，差异有统计学意义（p<0.01）。内镜组手术时间为 1.6±0.7 小时，开颅组为 5.2±1.8 小时，差异有统计学意义（p<0.01）。内镜组术中出血量为 91.4±93.1ml，开颅组为 605.6±602.3ml，差异有统计学意义（p<0.01）。内镜组术后 1 周 GCS 评分为 11.5±2.9，开颅组为 8.3±3.8，差异有统计学意义（p<0.01）。内镜组住院时间为 11.6±6.9 天，开颅组为 13.2±7.9 天，差异有统计学意义（p<0.05）。内镜组术后 6 个月 mRS 评分为 3.2±1.5，开颅组为 4.1±1.9，差异有统计学意义（p<0.01）。内镜组患者的恢复情况优于开颅组。数据以均数±标准差表示。
与传统开颅手术相比，内镜手术治疗幕上 HICH 更有效、创伤更小，可能改善患者预后。内镜手术是治疗幕上 HICH 的一种有前途的方法。随着内镜技术的发展，内镜清除术将在临床上得到更广泛的应用。需要前瞻性随机对照试验。
