神经内镜技术在原发性桥脑出血开颅血肿清除术中的应用与效果

Application and effectiveness of neuroendoscopy in craniotomy for hematoma clearance in treatment of primary pontine hemorrhage

摘要:

目的 探讨神经内镜联合显微镜开颅血肿清除术治疗原发性桥脑出血（PPH）的效果与安全性。方法 回顾性分析2016年1月—2023年8月于濮阳市安阳地区医院住院治疗的PPH患者66例。研究组（26例）采用神经内镜联合显微镜开颅血肿清除术，对照组（40例）采用单纯显微镜下开颅血肿清除术。评估两组患者术后血肿清除率、术后并发症发生率、术后病死率、术后1周格拉斯哥昏迷评分（GCS）及术后6个月格拉斯哥预后评分（GOS）情况。结果 研究组与对照组术后血肿清除率[（93.5±5.4）% vs. （85.8±8.7）%]、术后1周GCS（9.3±1.2 vs. 8.2±1.5）及术后6个月GOS（3.3±1.3 vs. 2.6±1.3）相比，差异均有统计学意义（P＜0.05），研究组均高于对照组。但两组术后再出血率、病死率比较，差异无统计学意义（P＞0.05）。结论 对PPH患者行显微开颅血肿清除术时，联合应用神经内镜技术可能有助于减少视野盲区，提高血肿清除率并降低术后再出血风险，同时减少术中神经功能损害，改善患者预后。

Abstract:

Objective To investigate the efficacy and safety of neuroendoscopy combined with microscopic craniotomy for hematoma clearance in the treatment of primary pontine hemorrhage （PPH）.Methods A retrospective analysis was performed for 66 patients with PPH who were hospitalized and treated in Anyang Regional Hospital of Puyang from January 2016 to August 2023. The 26 patients in the study group were treated with neuroendoscopy combined with microscopic craniotomy for hematoma clearance， and the 40 patients in the control group were treated with microscopic craniotomy for hematoma clearance alone. The two groups were assessed in terms of postoperative hematoma clearance rate， the incidence rate of postoperative complications， postoperative mortality， Glasgow coma scale （GCS） score at 1 week after surgery， and Glasgow outcome scale （GOS） score at 6 months after surgery.Results Compared with the control group， the study group had significantly higher postoperative hematoma clearance rate ［（93.5±5.4）% vs （85.8±8.7）%， P <0.05］， GCS score at 1 week after surgery （9.3±1.2 vs 8.2±1.5， P <0.05）， and GOS score at 6 months after surgery （3.3±1.3 vs 2.6±1.3， P <0.05）. However， there was no statistically significant difference in the postoperative rebleeding and mortality rates between the two groups（ P >0.05）.Conclusions For patients with PPH undergoing microscopic craniotomy for hematoma clearance， neuroendoscopy can help to reduce blind spots in the visual field， increase hematoma clearance rate， and reduce the risk of postoperative rebleeding and intraoperative neurological damage， thereby improving the prognosis of patients.