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幕上脑出血的外科治疗:内镜手术与开颅手术对比

Surgical Management of Supratentorial Intracerebral Hemorrhages: Endoscopic Versus Open Surgery.

作者信息

Eroglu Umit, Kahilogullari Gokmen, Dogan Ihsan, Yakar Fatih, Al-Beyati Eyyub S M, Ozgural Onur, Cohen-Gadol Aaron A, Ugur Hasan Caglar

机构信息

Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara, Turkey.

Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara, Turkey.

出版信息

World Neurosurg. 2018 Jun;114:e60-e65. doi: 10.1016/j.wneu.2018.02.056. Epub 2018 Mar 19.

Abstract

OBJECTIVE

Intracerebral hemorrhage continues to be a major global problem. No standard treatment or surgical procedure has been identified for intracerebral hemorrhages. High morbidity and mortality rates caused by conventional approaches and the disease itself have necessitated more-invasive treatment methods. The endoscopic approach is a more minimally invasive method than craniotomy, which is another alternative surgical treatment.

METHODS

We compared intracerebral hematoma drainage in 2 groups of 17 patients each, treated with minimally invasive endoscopic method versus craniotomy. All the patients were treated for supratentorial spontaneous hemorrhage between December 2013 and February 2017 at the Neurosurgery Clinic of Ankara University Faculty of Medicine.

RESULTS

We retrospectively evaluated 34 patients surgically treated between December 2013 and February 2017. All patients underwent surgery within the first 24 hours. Patients in the early surgery group had better surgical outcomes. In the neuroendoscopic group, Glasgow Coma Scale increased from 6 to 11 at 1 week postoperatively compared with 5 to 9 in the craniotomy group.

CONCLUSIONS

Minimally invasive endoscopic hematoma evacuation may be a good alternative surgical method for treating supratentorial spontaneous cerebral hematomas.

摘要

目的

脑出血仍然是一个重大的全球性问题。目前尚未确定针对脑出血的标准治疗方法或外科手术。传统方法及疾病本身所导致的高发病率和死亡率使得更具侵入性的治疗方法成为必要。与开颅手术(另一种可供选择的外科治疗方法)相比,内镜手术是一种创伤性更小的方法。

方法

我们比较了两组各17例患者的脑内血肿引流情况,一组采用微创内镜方法治疗,另一组采用开颅手术治疗。所有患者均于2013年12月至2017年2月在安卡拉大学医学院神经外科诊所接受幕上自发性脑出血治疗。

结果

我们回顾性评估了2013年12月至2017年2月期间接受手术治疗的34例患者。所有患者均在发病后24小时内接受手术。早期手术组患者的手术效果更好。神经内镜组患者术后1周时格拉斯哥昏迷量表评分从6分提高到11分,而开颅手术组从5分提高到9分。

结论

微创内镜血肿清除术可能是治疗幕上自发性脑血肿的一种良好的替代性外科手术方法。

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