两种微创手术方法治疗基底节区中度脑出血临床疗效的比较研究

Clinical efficacy of two minimally invasive surgeries for moderate cerebral hemorrhage in the basal ganglia: A comparative study

摘要:

目的 比较研究CT实时引导下软通道穿刺手术和小骨窗微创开颅手术治疗基底节区脑出血。方法 选取266例出血量在20~40毫升的基底节区脑出血患者，其中208例采用CT实时引导下软通道穿刺血肿腔手术（穿刺组），58例患者行微创开颅手术（开颅组）。两组病人从住院天数、水肿期意识加深情况、再出血率及预后等方面进行比较。结果 两组在平均住院天数（穿刺组11.53±0.418天VS开颅组11.30±0.778天）、入院3天GSC评分下降（穿刺组1.53±0.160分VS手术组1.48±0.232分）及再出血率（穿刺组1.92% VS开颅组1.72%）方面均无统计学差异（P>0.05）；而在出院时NIHSS评分提高方面，穿刺组较开颅组提高更显著（穿刺组2.98±0.247分VS开颅组2.05±0.186分，P<0.05）。结论 对于基底节区中度脑出血患者，血肿腔穿刺手术和微创开颅手术比较，前者预后改善较后者明显。

Abstract:

Objective To compare the efficacy of soft-channel puncture guided by computed tomography (CT) and minimally invasive craniotomy with a small bone window for the treatment of basal ganglia hemorrhage. Methods A total of 266 cases of basal ganglia hemorrhage with a blood loss of 20-40 ml were enrolled in this study. Of the 266 cases, 208 underwent soft-channel puncture of the hematoma cavity guided by CT (puncture group) and 58 underwent minimally invasive craniotomy (craniotomy group). The following indices were compared between the two groups:length of hospital stay, state of coma in cerebral edema stage, rebleeding incidence, and outcome. Results There were no significant differences in mean length of hospital stay, reduction in Glasgow Coma Scale score at 3 days after admission, and rebleeding incidence between the puncture group and the craniotomy group (11.53±0.418 days vs 11.30±0.778 days, P>0.05; 1.53±0.160 vs 1.48±0.232, P>0.05; 1.92% vs 1.72%, P>0.05). The puncture group had a significantly greater improvement in National Institutes of Health Stroke Scale score at discharge than the craniotomy group (2.98±0.247 vs 2.05±0.186, P<0.05). Conclusions For patients with moderate cerebral hemorrhage in the basal ganglia, puncture of the hematoma cavity leads to better prognosis compared with minimally invasive craniotomy.