术中超声引导神经内镜手术与脑室外引流术治疗脑室内血肿伴铸型的对比分析研究

A comparative study of intraoperative ultrasound-guided neuroendoscopic surgery and external ventricular drainage in the treatment of intraventricular hematoma with casts

摘要:

目的 对比分析术中超声引导神经内镜手术和脑室外引流术治疗脑室血肿伴铸型的安全性及有效性。方法 选取我科2016年5月至2018年11月间脑室血肿伴铸型的患者60例，根据脑室血肿伴铸型的类型分为三型，采取分层数字随机法将患者分成两组，对照组（n=30）采取传统的脑室外引流术治疗，实验组（n=30）则采取术中超声引导神经内镜下脑室内血肿清除术，比较两组临床疗效。结果 实验组术后24 h血肿清除率、术后24小时GCS评分、术后6月Barthel日常生活能力评分均明显高于对照组（P<0.05），实验组引流管带管时间、住院时间较对照组缩短，同时降低死亡率（P<0.05）；实验组术区再出血、分流依赖性脑积水、颅内感染与对照组比较无统计学差异（P>0.05）。结论 术中超声引导下神经内镜手术治疗脑室血肿伴铸型是安全、有效的，该治疗方案优于脑室外引流术。

Abstract:

Objective To compare the safety and efficacy of intraoperative ultrasound-guided neuroendoscopic surgery and external ventricular drainage in the treatment of intraventricular hematoma with casts.Methods Sixty patients with intraventricular hemorrhage (IVH) with casts who were treated in our department from May 2016 to November 2018 were enrolled and divided into three types according to the classification of IVH with casts. Meanwhile, the patients were divided into two groups using the stratified random sampling method. The control group was treated with conventional external ventricular drainage (n=30) and the experimental group was treated with intraoperative ultrasound-guided neuroendoscopic intraventricular hematoma clearance (n=30). The two groups were compared for efficacy.Results Compared with the control group, the experimental group had significantly increased hematoma clearance rate at 24 h after surgery, Glasgow Coma Scale score at 24 h after surgery, and Barthel Index for Activities of Daily Living at 6 months after surgery (P<0.05). Meanwhile, the experimental group had significantly reduced drainage tube indwelling duration, length of hospital stay, and mortality rate compared with the control group (P<0.05). There were no significant differences between the two groups in the incidence of rebleeding, shunt-dependent hydrocephalus, and intracranial infection (P>0.05).Conclusions Intraoperative ultrasound-guided neuroendoscopic surgery is safe and effective in treating IVH with casts. It is superior to external ventricular drainage.