[1]唐清明,侯黎明,汪棋笙,等.神经内镜手术与经外侧裂-岛叶入路显微手术治疗自发性基底节区血肿的疗效[J].中国临床神经外科杂志,2024,29(11):665-669.[doi:10.13798/j.issn.1009-153X.2024.11.006]
　TANG Qing-ming,HOU Li-ming,WANG Qi-sheng,et al.Clinical efficacy of neuroendoscopic surgery and microsurgery via the lateral fissure-insular approach for spontaneous basal ganglia hematomas[J].,2024,29(11):665-669.[doi:10.13798/j.issn.1009-153X.2024.11.006]
点击复制

神经内镜手术与经外侧裂-岛叶入路显微手术治疗自发性基底节区血肿的疗效()
分享到：

《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
29
期数:
2024年11期
页码:
665-669
栏目:
论著
出版日期:
2024-11-30

文章信息/Info

Title:
Clinical efficacy of neuroendoscopic surgery and microsurgery via the lateral fissure-insular approach for spontaneous basal ganglia hematomas
文章编号:
1009-153X（2024）11-0665-05
作者:
唐清明; 侯黎明; 汪棋笙; 李华国
1646200四川泸州，合江县人民医院神经外科（唐清明、侯黎明、汪棋笙、李华国）
Author(s):
TANG Qing-ming;  HOU Li-ming;  WANG Qi-sheng;  LI Hua-guo
Department of Neurosurgery, Hejiang County People's Hospital, Luzhou 646200, China
关键词:
自发性脑出血; 基底节区血肿; 神经内镜手术; 显微手术; 经外侧裂-岛叶入路; 疗效
Keywords:
Spontaneous intracerebral hemorrhage;  Basal ganglia hematoma;  Neuroendoscopic surgery;  Microsurgery;  Lateral fissure-insular approach;  Clinical efficacy
分类号:
R 743.34; R 651.1+2
DOI:
10.13798/j.issn.1009-153X.2024.11.006
文献标志码:
A
摘要:
目的 对比分析神经内镜手术和经外侧裂-岛叶入路显微手术治疗原发性基底节区血肿的疗效。方法 回顾性分析2020年1月至2023年5月手术治疗的100例原发性基底节区出血的临床资料。50例采用神经内镜手术（观察组），50例采用经外侧裂-岛叶入路显微手术（对照组）。结果 观察组与对照组血肿清除率无统计学差异[（97.0±3.5）% vs. （96.1±3.6）%；P=0.195]，但是观察组手术时间[（73.36±14.41）min vs. （87.88±22.47）min；P<0.001]和术中出血量[（31.30±8.62）ml vs. （65.60±13.65）ml；P<0.001]明显减少。术前，观察组美国国立卫生研究院卒中量表（NIHSS）评分[（18.94±5.45）分]、改良Rankin量表（mRS）评分[（4.02±0.92）分]与对照组[分别为（17.64 ±5.60）分、（4.08±0.83）分]无统计学差异（P>0.05）；术后3个月，观察组NIHSS评分[（9.92±4.51）分]和mRS评分[（2.28 ±1.07）分]较术前明显降低（P<0.05），对照组NIHSS评分[（11.92±4.84）分]和mRS评分[（2.96±0.97）分]较术前明显降低（P<0.05），但是观察组NIHSS评分和mRS评分明显优于对照组（P<0.05）。结论 对于自发性基底节区血肿，神经内镜手术和经外侧裂-岛叶入路显微手术均具有良好的清除效果，明显改善病人的预后，但是神经内镜手术具有手术时间少、术中出血量少的优势。
Abstract:
Objective To compare and analyze the efficacy of neuroendoscopic surgery and microsurgery via the lateral fissure-insular approach for patients with primary basal ganglia hematomas. Methods The clinical data of 100 patients with primary basal ganglia hemorrhage who underwent surgical treatment from January 2020 to May 2023 were retrospectively analyzed. Among them, 50 cases were treated with neuroendoscopic surgery (observation group), and 50 cases were treated with microsurgery via the lateral fissure-insular approach (control group). Results There was no statistically significant difference in hematoma evacuation rate between the two groups [(97.0±3.5)% vs. (96.1±3.6)%; P=0.195]. However, the operation time of the observation group was significantly shorter than that of the control group [(73.36±14.41) min vs. (87.88±22.47) min; P<0.001], and the intraoperative blood loss was also significantly less [(31.30±8.62) ml vs. (65.60±13.65) ml; P<0.001]. Before surgery, there was no statistically significant difference in the National Institutes of Health Stroke Scale (NIHSS) score [(18.94±5.45) points] and the modified Rankin Scale (mRS) score [(4.02±0.92) points] of the observation group and those [(17.64±5.60) points and (4.08±0.83) points, respectively] of the control group (P>0.05). Three months postoperatively, the NIHSS score [(9.92±4.51) points] and the mRS score [(2.28±1.07) points] in the observation group were significantly decreased compared with those preoperatively (P<0.05), and the NIHSS score [(11.92±4.84) points] and the mRS score [(2.96±0.97) points] in the control group were also significantly decreased compared with those preoperatively (P<0.05); however, the NIHSS score and the mRS score in the observation group were significantly superior to those in the control group (P<0.05). Conclusions Both neuroendoscopic surgery and microsurgery via the lateral fissure-insular approach can effectively evacuate hematoma and improve the prognosis of patients with spontaneous basal ganglia hemorrhage, but neuroendoscopic surgery has significant advantages in shortening operation time and reducing intraoperative blood loss.

参考文献/References:

[1] XU XH, YE XH, LI JW, et al. Association between remote diffusion-weighted imaging lesions and cerebral small vessel disease in primary intracerebral hemorrhage [J]. Eur J Neurol, 2019, 26(7): 961-968.
[2] JIANG YB,WEI K Y, ZHANG XY, et al. White matter repair and treatment strategy after intracerebral hemorrhage [J]. CNS Neurosci Ther, 2019, 25(10): 1113-1125.
[3] TAO SC, XIONG ZW, CAO CJ, et al. Standardized procedure of neuroendoscopic surgery via coronal suture- middle frontal gyrus approach for patients with hypertensive basal ganglia haemorrhage [J]. Chin J Clin Neurosurg, 2022, 27(3): 174-177, 181. 陶肆才，熊忠伟，曹长军，等. 经冠状缝-额中回入路神经内镜手术治疗高血压性基底节区出血的标准化流程分析[J]. 中国临床神经外科杂志，2022，27（3）：174-177，181.
[4] LI ZY, WANG WJ, WEI HY, et al. Clinical effect and safety of 3Dslicer combined with neuroendoscopic surgery in the treatment of hypertensive basal ganglia cerebral hemorrhage [J]. Chin Med, 2021, 16(9): 1334-1338. 李知阳，王文举，魏航宇，等. 3D-slicer软件联合神经内镜手术治疗高血压基底节区脑出血的临床效果及安全性[J]. 中国医药，2021，16（9）：1334-1338.
[5] HUANG YS, LI BH, LI Y, et al. Clinical effect analysis of different ultra-early surgical interventions on hypertensive cerebral hemorrhage [J]. Chin J Clin (Electr Edition), 2016, 10(8): 1195-1197. 黄宜生，李伯和，余 力，等. 不同超早期手术干预对高血压脑出血的临床疗效分析[J]. 中华临床医师杂志（电子版），2016，10（8）：1195-1197.
[6] FAN K, BA YF, YU XT, et al. Effect of 3D-slicer software combined with microscopic small bone window in the treatment of hypertensive basal ganglia hemorrhage [J]. Chin J Stereotac Func Neurosurg, 2022, 35(6): 338-342, 364. 范　奎，巴永锋，滑祥廷，等. 3D-slicer软件联合显微镜小骨窗治疗高血压性基底节脑出血疗效观察[J]. 立体定向和功能性神经外科杂志，2022，35（6）：338-342，364.
[7] HECHT N, CZABANKA M, KENDLBACHER P, et al. Intraoperative CT and cone- beam CT imaging for minimally invasive evacuation of spontaneous intracerebral hemorrhage [J]. Acta Neurochir (Wien), 2020, 162(12): 3167-3177.
[8] CAO Y, ZHANG Q, YU T, et al. Chinese Guidelines for the Clinical Management of Cerebrovascular Diseases (Excerpted edition): clinical management of cerebral hemorrhage [J]. Chin J Stroke, 2019, 14 (8): 809-813. 曹　勇，张　谦，于　洮，等. 中国脑血管病临床管理指南（节选版）——脑出血临床管理[J]. 中国卒中杂志，2019，14（8）：809-813.
[9] ZHAO W, YUAN JW, SONG T, et al. Comparative study of transfrontal gyrus endoscopy-assisted removal of hematoma in basal ganglia with conventional craniotomy [J]. Chin J Prac Nerv Dis, 2020, 23(17): 1534-1538. 赵　伟，袁建伟，宋　腾，等. 经额中回内镜辅助与常规开颅清除基底节区血肿的对比研究[J]. 中国实用神经疾病杂志，2020，23（17）：1534-1538.
[10] GE X, CHEN XL, SUN JQ, et al. Neuroendoscopy via kocher's point and middle frontal gyrus approach under simple navigation for minimally invasive surgical treatment of thalamic hemorrhage breaking into ventricles [J]. Chin J Nervous Mental Dis, 2017, 43 (3): 176-179. 葛　新，陈晓雷，孙吉庆，等. 简易导航下神经内镜经kocher点额中回入路微创手术治疗丘脑出血破入脑室[J]. 中国神经精神疾病杂志，2017，43（3）：176-179.
[11] XIA Q, QIN F, LIU HY, et al. Comparison of curative effect of small bone window craniotomy hematoma removal and neuroendoscopic hematoma removal via lateral fissure approach on hypertensive intracerebral hemorrhage [J]. Chin J Pract Nerv Dis, 2023, 26(9): 1156-1161. 夏　芹，覃　凡，刘泓渊，等. 小骨窗开颅血肿清除术与神经内镜下经外侧裂入路血肿清除术治疗高血压脑出血疗效对比[J]. 中国实用神经疾病杂志，2023，26（9）：1156-1161.
[12] SUN Q, LIU YC, YOU WC, et al. Analysis of curative effects of surgery through transsylvian-insular approach on hypertensive basal ganglia hemorrhage [J]. Chin J Clin Neurosurg, 2019, 24(1): 16-18. 孙　青，刘永春，尤万春，等. 经外侧裂-岛叶入路手术治疗高血压性基底节区出血的疗效分析[J]. 中国临床神经外科杂志，2019，24（1）：16-18.
[13] LIU HB, WEI LF, ZHAO L, et al. Comparative study on stereotactic microimpact burr-holedrainage and conservative treatment for conscious patients of hypertensive cerebral hemorrhage in basal ganglia area [J]. J Clin Neurosurg, 2018, 15(1): 38-41, 45. 刘海兵，魏梁锋，赵　琳，等. 立体定向微创钻孔引流与保守治疗未昏迷的基底节区出血患者的疗效对比[J]. 临床神经外科杂志，2018，15（1）：38-41，45.
[14] ZHU HL, ZHANG W. Clinical effect of stereotactic surgery in the treatment of small amount of hypertensive basal ganglia intracerebral hemorrhage [J]. Chin Foreign Med Res, 2023, 21(17): 155-158. 朱火灵，张　巍. 立体定向术治疗少量高血压性基底节区脑出血的临床效果[J]. 中外医学研究，2023，21（17）：155-158.
[15] YU H, GUO XL, MA K, et al. Simple posture-assisted transfrontal puncture evacuation for hypertensive basal ganglia hemorrhage [J]. Chin J Clin Neurosurg, 2017, 22(7): 480-482. 余　浩，郭西良，马　奎，等. 简易体位辅助经额穿刺引流术治疗高血压性基底节区出血[J]. 中国临床神经外科杂志，2017，22（7）：480-482.

相似文献/References:

[1]朱郭婷　陈思思　黄书岚.血清淀粉样蛋白A与自发性脑出血预后的关系[J].中国临床神经外科杂志,2017,(08):539.[doi:10.13798/j.issn.1009-153X.2017.08.005]
　ZHU Guo-ting,CHEN Si-si,HUANG Shu-lan..Relationship of serum level of amyloid protein A with prognoses in patients with acute spontaneous intracerebral hemorrhage[J].,2017,(11):539.[doi:10.13798/j.issn.1009-153X.2017.08.005]
[2]刘海兵　魏梁锋　洪景芳　王守森　薛　亮　张尚明.经外侧裂-岛叶入路显微手术治疗基底节区血肿[J].中国临床神经外科杂志,2017,(09):656.[doi:10.13792017.09/j.issn.1009-153X.2017.09.017]
[3]廖建明 综述　陈谦学 审校.自发性脑出血急性期药物治疗研究进展[J].中国临床神经外科杂志,2017,(12):857.[doi:10.13798/j.issn.1009-153X.2017.12.021]
[4]林清国　杨　修　杨武双　刘东辉　王文阳　孟　涵　郑家地　黄惠勇.亚低温治疗自发性脑出血的临床疗效和安全性[J].中国临床神经外科杂志,2018,(04):240.[doi:10.13798/j.issn.1009-153X.2018.04.006]
　LIN Qing-guo,YANG Xiu,YANG Wu-shuang,et al.Curative effects of mild hypothermia on spontaneous intracerebral hemorrhage and its safety[J].,2018,(11):240.[doi:10.13798/j.issn.1009-153X.2018.04.006]
[5]王　鹏　刘丽娜　王志明　蔡　明.以脑出血为首发症状的绒毛膜癌脑转移1例[J].中国临床神经外科杂志,2018,(06):447.[doi:10.13798/j.issn.1009-153X.2018.06.024]
[6]王 龙,陈谦学,刘骏辉,等.颅内压监测辅助下钻孔引流术治疗自发性脑出血的临床疗效分析[J].中国临床神经外科杂志,2018,(09):581.[doi:10.13798/j.issn.1009-153X.2018.09.002]
　WANG Long,CHEN Qian-xue,LIU Jun-hui,et al.Clinical effects of drainage of hematoma cavity under intracranial pressure monitoring on spontaneous intracerebral hemorrhage[J].,2018,(11):581.[doi:10.13798/j.issn.1009-153X.2018.09.002]
[7]吴　勇、黄书岚、观龙彬、容嘉彬.右美托咪定联合地佐辛在自发性脑出血开颅术后镇静、镇痛中的疗效观察[J].中国临床神经外科杂志,2019,(08):480.[doi:10.13798/j.issn.1009-153X.2019.08.010]
　WU Yong,HUANG Shu-lan,GUAN Long-bin,et al.Effect of dezocine combined with dexmedetomidine on the analgesia and sedation after craniotomy in patients with spontaneous intracerebral hemorrhage[J].,2019,(11):480.[doi:10.13798/j.issn.1009-153X.2019.08.010]
[8]周厚杰　刘宏斌　吴　涛　郭　强.神经内镜下手术清除脑内血肿的疗效分析[J].中国临床神经外科杂志,2019,(05):308.[doi:10.13798/j.issn.1009-153X.2019.05.018]
[9]聂　盼　张修民　杨　鑫　柳　雯　付　锴　陈劲草　江普查　张　捷.自发性脑出血合并肾功能不全CRRT治疗分析[J].中国临床神经外科杂志,2021,26(05):346.[doi:10.13798/j.issn.1009-153X.2021.05.009]
　NIE Pan,ZHANG Xiu-min,YANG Xin,et al.Analysis of CRRT for patients with spontaneous intracerebral hemorrhage associated with renal insufficiency[J].,2021,26(11):346.[doi:10.13798/j.issn.1009-153X.2021.05.009]
[10]孙树平　石长斌.自发性脑实质出血继发脑室出血的治疗进展[J].中国临床神经外科杂志,2021,26(11):891.[doi:10.13798/j.issn.1009-153X.2021.11.024]

备注/Memo

备注/Memo:
（2023-07-26收稿，2024-05-20修回）
基金项目：2022年合江县人民医院专项科研课题（2022HJSRY08）；2022年四川省医学（青年创新）科研课题（Q22024）
通信作者：侯黎明，Email：550392881@qq.com
更新日期/Last Update: 2024-11-30