Department of Neurosurgery, Affiliated Hospital of Guangdong Medical University, Zhangjiang, China.
J Craniofac Surg. 2021;32(1):e77-e80. doi: 10.1097/SCS.0000000000006986.
The aim of this study is to analyze the clinical effect of small bone-window craniotomy with microscope combined postoperative ICP monitoring, and further explore an appropriate treatment for HICH patients.
One hundred fifty patients with HICH were selected according to inclusion and exclusion criteria and divided into 3 groups at random, 50 each group. Patients in 3 groups were treated with conventional craniotomy, small bone-window craniotomy and small bone-window craniotomy combined ICP monitoring respectively. The surgical efficiency, treatment effect and outcomes were recorded and analyzed.
The intraoperative blood loss and operation time of small window groups were significantly less than that of conventional group, and the hematoma clearance rate in small window groups were significantly higher than in conventional group (P < 0.05). Compared with conventional group, the hospital stays and mannitol dose used were less in small window groups and least in small window combined ICP monitoring group (P < 0.05). The complication rate in small window combined ICP monitoring group was 10%, which was significantly lower than in conventional group (26%, P < 0.05), while no significant difference was found between small window group (18%) compared with the other 2 groups respectively (P > 0.05). The difference of morality rate between 3 groups wasn't significant (P > 0.05). Three treatment significantly increased the Barthel index score, and the improvement of small window combined ICP monitoring group was significantly higher than in other 2 groups respectively (P < 0.05), while the difference between this two groups wasn't significant (P > 0.05).
Small bone-window craniotomy is more efficient and convenient than conventional craniotomy in the treatment of HICH. In the meantime, small bone-window craniotomy simultaneous with ICP monitoring significantly improved clinical effect and treatment outcomes of HICH patients.
本研究旨在分析显微镜下小骨窗开颅术联合术后 ICP 监测的临床效果，并进一步探讨 HICH 患者的合适治疗方法。
根据纳入和排除标准，选择 150 例 HICH 患者，随机分为 3 组，每组 50 例。3 组患者分别采用常规开颅术、小骨窗开颅术和小骨窗开颅术联合 ICP 监测治疗。记录并分析手术效率、治疗效果和转归。
小骨窗组术中出血量和手术时间明显少于常规组，小骨窗组血肿清除率明显高于常规组（P<0.05）。与常规组相比，小骨窗组的住院时间和甘露醇用量较少，小骨窗联合 ICP 监测组最少（P<0.05）。小骨窗联合 ICP 监测组并发症发生率为 10%，明显低于常规组（26%，P<0.05），小骨窗组与其他两组比较差异无统计学意义（P>0.05）。3 组死亡率差异无统计学意义（P>0.05）。3 种治疗方法均明显提高了 Barthel 指数评分，小骨窗联合 ICP 监测组的改善明显高于其他两组（P<0.05），但两组之间差异无统计学意义（P>0.05）。
小骨窗开颅术治疗 HICH 比常规开颅术更有效、更方便。同时，小骨窗开颅术联合 ICP 监测能显著改善 HICH 患者的临床效果和治疗结局。
