[1]陶肆才　熊忠伟　曹长军　周建军　孙宗汉　陈劲草.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(03):174-177.[doi:10.13798/j.issn.1009-153X.2022.03.009]
　TAO Si-cai,XIONG Zhong-wei,CAO Chang-jun,et al.Standardized procedure of neuroendoscopic surgery via coronal suture-middle frontal gyrus approach for patients with hypertensive basal ganglia haemorrhage[J].,2022,27(03):174-177.[doi:10.13798/j.issn.1009-153X.2022.03.009]
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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()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
27
期数:
2022年03期
页码:
174-177
栏目:
论著
出版日期:
2022-03-31

文章信息/Info

Title:
Standardized procedure of neuroendoscopic surgery via coronal suture-middle frontal gyrus approach for patients with hypertensive basal ganglia haemorrhage
文章编号:
1009-153X（2022）03-0174-04
作者:
陶肆才　熊忠伟　曹长军　周建军　孙宗汉　陈劲草
430071 武汉，武汉大学中南医院神经外科（陶肆才、熊忠伟、曹长军、陈劲草）；432000 湖北孝感，云梦县人民医院神经外科（周建军）；432000 湖北孝感，安陆市普爱医院神经外科（孙宗汉）
Author(s):
TAO Si-cai1;  XIONG Zhong-wei1;  CAO Chang-jun1;  ZHOU Jian-jun2;  SUN Zong-han3;  CHEN Jin-cao1.
1. Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan 430071, China; 2. Department of Neurosurgery, People`s Hospital of Yunmeng County, Xiaogan 432000, China; 3. Department of Neurosurgery, Anlu Puai Hospital, Xiaogan 432000, China
关键词:
高血压性脑出血; 基底节区; 神经内镜; 经冠状缝-额中回入路; 血肿清除术; 标准化流程
Keywords:
Hypertensive basal ganglia haemorrhage;  Neuroendoscopy;  Coronal suture-middle frontal gyrus approach
分类号:
A
DOI:
10.13798/j.issn.1009-153X.2022.03.009
文献标志码:
R 743.34; R 651.1+2
摘要:
目的 总结一种简单实施、有效的、标准的经冠状缝-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。方法 回顾性分析2019年4月至2021年4月按统一标准实施的经冠状缝-额中回入路神经内镜手术治疗的48例高血压性基底节区出血的临床资料。术中未使用神经导航及3D-slicer等软件辅助定位。结果 术后24 h内复查头CT显示残余血肿量中位数为2.4（1.1~3.9）ml；血肿清除率中位数为94.0%（90.0%~98.0%）。无术后再出血。出院时GCS评分中位数为13（11~14）分。术后随访6~30个月（中位数15个月），mRS评分0~2分35例，3~4分10例，5~6分3例。结论 神经内镜下经冠状缝-额中回入路手术治疗高血压性基底节区出血是一种简单易行的手术方式，无需神经导航及3D-slicer等软件辅助定位，可以取得良好的手术效果。
Abstract:
Objective To summarize a simple-to-use, standardized and effective procedure of neuroendoscopic surgery via middle coronal suture-frontal gyrus approach for the patients with hypertensive basal ganglia haemorrhage (HBGH). Methods The clinical data of 48 patients with HBGH who received neuroendoscopic surgery via coronal suture-middle frontal gyrus approach from April 2019 to April 2021 were analyzed retrospectively. Software-assisted positioning such as neuronavigation and 3D-slicer was not used during the operation. Results CT within 24 hours after operation showed that the median volume of residual hematoma was 2.4 (1.1~3.9) ml, and the median rate of hematoma clearance was 94.0% (90.0%~98.0%). There was no postoperative rebleeding. The median GCS score at discharge was 13 (11~14). Postoperative follow-up (range, 6~30 months; median, 15 months) showed that mRS score of 0~2 was achieved in 35 patients, score of 3~4 in 10, and score of 5~6 in 3. Conclusions Neuroendoscopic surgery via coronal suture-middle frontal gyrus approach for the patients with HBGH is a simple and easy operation. It does not require software-assisted positioning such as neuronavigation and 3D-slicer, and can achieve a good outcome.

参考文献/References:

[1] 刘　军，陈汉平，叶　辉. 高血压性基底节脑出血的治疗体会[J]. 中国临床神经外科杂志，2011，16（6）：368-369.
[2] 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.
[3] Xia Z, Wu X, Li J, et al. Minimally invasive surgery is su-perior to conventional craniotomy in patients with sponta-neous supratentorial intracerebral hemorrhage: a systematic review and meta-analysis [J]. World Neurosurg, 2018, 115:266-273.
[4] 郭传军，杨凤海，张连群，等. 小骨窗显微手术治疗基底节区高血压脑出血246例[J]. 中国临床神经外科杂志，2009，14（9）：548-549.
[5] 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.
[6] 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.
[7] 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.
[8] 罗　成，朱志峰，殷义明，等. 经额上沟入路神经内镜辅助脑内血肿清除术治疗高血压脑出血的效果观察 [J]. 临床和实验医学杂志，2019，18（21）：2320-2322.
[9] 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] Fu C, Wang N, Chen B, et al. Surgical management of mo-derate basal ganglia intracerebral hemorrhage: comparison of safety and efficacy of endoscopic surgery, minimally invasive puncture and drainage, and craniotomy [J]. World Neurosurg, 2019, 122: e995-e1001.
[11] Katsuki M, Narita N, Sato K, et al. Where to make burr hole for endoscopic hematoma removal against intracerebral hemorrhage at the basal ganglia to increase the hematoma removal rate--comparison between trans-forehead and along-the-long-axis approaches [J]. Surg Neurol Int, 2021, 12: 41.
[12] 中国急诊急救神经内镜治疗高血压性脑出血协作组，中国医药教育协会神经内镜与微创医学专业委员会，中华医学会神经外科分会. 2020神经内镜下高血压性脑出血手踔瘟浦泄夜彩?[J]. 中华医学杂志，2020，100（33）：2579-2585.
[13] Miller CM, Vespa P, Saver JL, et al. Image-guided endo-scopic evacuation of spontaneous intracerebral hemorrhage[J]. Surg Neurol, 2008, 69(5): 441-446.
[14] Chartrain AG, Kellner CP, Fargen KM, et al. A review and comparison of three neuronavigation systems for minimally invasive intracerebral hemorrhage evacuation [J]. J Neuro-interv Surg, 2018, 10(1): 66-74.

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更新日期/Last Update: 1900-01-01