Sun Guoqing, Li Xiaolong, Chen Xiangtao, Zhang Yuhai, Xu Zhen
Department of Neurosurgery, Rizhao Peoples Hospital Affiliated with Jining Medical University.
Department of Neurosurgery, Rizhao Central Hospital.
Medicine (Baltimore). 2019 Jan;98(2):e14123. doi: 10.1097/MD.0000000000014123.
By comparing the intraoperative and postoperative conditions under different surgical methods, namely, keyhole endoscopy and craniotomy, we aim to provide more reasonable surgical treatment for patients with hypertensive cerebral hemorrhage.Eighty-nine patients with cerebral hemorrhage at Rizhao People's Hospital between January 2015 and December 2016 were analyzed retrospectively. Patients were assigned to the keyhole endoscopy group and the craniotomy group. The intraoperative (the duration of operation, operative blood transfusion and loss, and hematoma clearance rate) and the postoperative parameters (death rate, rebleeding rate, edema, and postoperative activity of daily living [ADL] scores) of the 2 groups were compared.Compared with the craniotomy group, the keyhole endoscopy group exhibited decreases in mean blood loss (P < .05, 180 ± 13.6 mL vs 812 ± 35.2 mL), blood transfusion (P < .05, 0 mL vs 480 ± 13.6 mL), the average surgical duration of operation (P < .05, 113 ± 14.3 minutes vs 231 ± 26.1 minutes), and the severe edema rate (P < .05, 10.9% vs 72.1%) and increases in the average hematoma clearance rate (P < .05, 95.6% vs 82.3%) and postoperative ADL scores (P < .05, 85.2% vs 39.0%). Neither the death rate (P > .05, 4.3% vs 4.7%) nor rebleeding rate (P > .05, 2.2% vs 2.3%) showed any obvious changes.Keyhole endoscopy for the treatment of hypertensive intracerebral hemorrhage has the advantages of minimal trauma with good effects, and its main reason for short operation time, reduced bleeding, and high hematoma clearance rate is the "brain-hematoma" pressure gradient. Use of the intraoperative micropull technique and removal of intracerebral hematoma in the shortest time possible are critical factors contributing to the high ADL scores in the keyhole endoscopy group. However, further validation on a larger sample size is required.
通过比较不同手术方法（即锁孔内镜手术和开颅手术）的术中及术后情况，我们旨在为高血压脑出血患者提供更合理的手术治疗。回顾性分析了2015年1月至2016年12月在日照市人民医院的89例脑出血患者。将患者分为锁孔内镜组和开颅手术组。比较两组的术中参数（手术时长、术中输血量及失血量、血肿清除率）和术后参数（死亡率、再出血率、水肿情况及术后日常生活活动能力[ADL]评分）。与开颅手术组相比，锁孔内镜组的平均失血量（P<0.05，180±13.6 mL对812±35.2 mL）、输血量（P<0.05，0 mL对480±13.6 mL）、平均手术时长（P<0.05，113±14.3分钟对231±26.1分钟）及重度水肿率（P<0.05，10.9%对72.1%）均降低，平均血肿清除率（P<0.05，95.6%对82.3%）及术后ADL评分（P<0.05，85.2%对39.0%）升高。死亡率（P>0.05，4.3%对4.7%）和再出血率（P>0.05，2.2%对2.3%）均无明显变化。锁孔内镜治疗高血压脑出血具有创伤小、效果好的优点，其手术时间短、出血少、血肿清除率高的主要原因是“脑-血肿”压力梯度差。术中使用微牵拉技术并尽可能在最短时间内清除脑内血肿是锁孔内镜组ADL评分高的关键因素。然而，需要更大样本量进一步验证。
