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神经内镜微创等3种术式对高血压脑出血病人血肿微创清除的价值比较

孙杰 常谦 吴泽宇 赵楠 刘兴海 苏平 刘俊 高鸿 李俊彦 岑键昌 刘博虎

孙杰, 常谦, 吴泽宇, 赵楠, 刘兴海, 苏平, 刘俊, 高鸿, 李俊彦, 岑键昌, 刘博虎. 神经内镜微创等3种术式对高血压脑出血病人血肿微创清除的价值比较[J]. 分子影像学杂志, 2020, 43(2): 253-258. doi: 10.12122/j.issn.1674-4500.2020.02.15
引用本文: 孙杰, 常谦, 吴泽宇, 赵楠, 刘兴海, 苏平, 刘俊, 高鸿, 李俊彦, 岑键昌, 刘博虎. 神经内镜微创等3种术式对高血压脑出血病人血肿微创清除的价值比较[J]. 分子影像学杂志, 2020, 43(2): 253-258. doi: 10.12122/j.issn.1674-4500.2020.02.15
Jie SUN, Qian CHANG, Zeyu WU, Nan ZHAO, Xinghai LIU, Ping SU, Jun LIU, Hong GAO, Junyan LI, Jianchang CEN, Bohu LIU. Comparison of the value of three types of neuroendoscopic minimally invasive surgery for the minimally invasive clearance of hematoma in patients with hypertensive intracerebral hemorrhage[J]. Journal of Molecular Imaging, 2020, 43(2): 253-258. doi: 10.12122/j.issn.1674-4500.2020.02.15
Citation: Jie SUN, Qian CHANG, Zeyu WU, Nan ZHAO, Xinghai LIU, Ping SU, Jun LIU, Hong GAO, Junyan LI, Jianchang CEN, Bohu LIU. Comparison of the value of three types of neuroendoscopic minimally invasive surgery for the minimally invasive clearance of hematoma in patients with hypertensive intracerebral hemorrhage[J]. Journal of Molecular Imaging, 2020, 43(2): 253-258. doi: 10.12122/j.issn.1674-4500.2020.02.15

神经内镜微创等3种术式对高血压脑出血病人血肿微创清除的价值比较

doi: 10.12122/j.issn.1674-4500.2020.02.15
基金项目: 

昆明市卫生科技计划资助项目 2018-04-04-001

云南省卫生科技计划资助项目 2018NS0167

详细信息
    作者简介:

    孙杰,硕士,主治医师,E-mail: 776493969@qq.com

    通讯作者:

    常谦,硕士,E-mail: CQ220@163.com

Comparison of the value of three types of neuroendoscopic minimally invasive surgery for the minimally invasive clearance of hematoma in patients with hypertensive intracerebral hemorrhage

  • 摘要: 目的比较并评价神经内镜微创手术与小骨窗开颅术和颅骨钻孔+尿激酶输注+导管引流术对高血压脑出血病人血肿清除的疗效和安全性。方法采用随机法将90例HICH患者分为3组:小骨窗开颅术(A组),颅骨钻孔+尿激酶输注+导管引流术(B组),神经内镜手术(C组),每组30例。比较3组患者的血肿清除率、死亡率、GCS评分、GOS评分、再出血率、肺炎发生率、颅内感染率等并发症。ELISA方法测量所有脑出血患者外周血IL-4、IL-6、IL-8、IL-10和S100β蛋白水平。结果成功完成所纳入的各组脑出血患者手术,A组、B组、C组患者血肿清除率分别为74.5%、43.1%、88.2%,差异有统计学意义(P < 0.05)。C组患者手术时间、再出血率、肺炎发生率、死亡率低于A组和B组(P < 0.05)。手术6月后GOS评分显示C组患者Ⅰ级和Ⅱ级人数高于A组和B组(P < 0.05),而III级、IV级和V级人数分别低于A组和B组(P < 0.05)。C组患者术后72 h外周血液IL-10水平高于A组和B组(P < 0.05),而IL-4、IL-6和IL-8水平低于A组和B组(P < 0.05)。在术后28 d,C组患者血清S100β蛋白水平低于A组和B组(P < 0.05)。结论神经内镜技术的微创、直观、较高的血肿清除率,较低的并发症发生率和明显改善临床预后,可能是治疗高血压脑出血更有前景的手术方法。

     

  • 图  1  三种手术HICH患者血肿的清除效果比较

    A:神经内窥镜术后; B:神经内窥镜术前; C:小骨窗开颅术后; D:小骨窗开颅术前; E:颅骨钻孔+尿激酶输注+导管引流术后; F:颅骨钻孔+尿激酶输注+导管引流术前

    Figure  1.  Comparison the hematoma evacuation of the patients with HICH in the three surgical approaches

    图  2  3组HICH患者外周血中IL-4、IL-6、IL-8、IL-10水平比较

    P < 0.05 vs A、B组; Pre-Op:术前; Post-Op:术后

    Figure  2.  Comparison of levels of IL-4, IL-6, IL-8, IL-10 of the patients with HICH in peripheral blood among three group

    图  3  3组HICH患者血清S-100β蛋白含量变化

    *P < 0.05 vs A、B组

    Figure  3.  Changes in the content of serum S100β protein of the patients with HICH among three groups

    表  1  HICH患者一般情况(n=30, Mean±SD)

    Table  1.   General information of the patients with HICH among three groups

    指标 A组 B组 C组
    年龄(岁) 56.4±14.4 57.4±12.6 58.6±10.2
    性别(男/女) 16/14 17/13 15/15
    术前GCS评分(分) 8.2±2.0 8.3±2.3 8.6±2.0
    术后GCS评分(分) 10.2±3.8 11.9±3.8 12.1±4.5
    术前血肿(mL) 58.6±10.2 46.3±18.0 55.7±14.6
    术后血肿(mL) 8.1±6.0 21.0±16.4# 4.2±5.1
    #P < 0.05 vs A组; P < 0.05 vs A、B组. A组: 小骨窗开颅术组; B组: 颅骨钻孔+尿激酶输注+导管引流术; C组:神经内镜手术组; GCS: Glasgow Coma Scale; HICH: Hypertensive intracerebral hemorrhage.
    下载: 导出CSV

    表  2  3组HICH患者手术效果的比较(n=30)

    Table  2.   Comparison of operative result of the patients with HICH among three groups

    指标 A组 B组 C组
    手术时间(min, Mean±SD) 142±9.8 36.9±7.1# 96±7.9
    血肿清除率(%) 74.5 43.1# 88.2
    再出血率(%) 6.0 18.2# 3.0
    肺炎发生率(%) 24.0 9.1# 5.0
    颅内感染率(%) 0 13.6# 0
    死亡率(%) 10.0 13.6# 3.3
    #P < 0.05 vs A组; P < 0.05 vs A、B组.
    下载: 导出CSV

    表  3  3组预后疗效比较[n=30, n (%)]

    Table  3.   Comparison of prognosis efficacy of the patients with HICH among three groups

    分级 A组 B组 C组
    I级 2 (6.67) 3 (10.00) 6 (20.00)
    II级 5 (16.67) 6 (20.00) 10 (33.33)
    III级 8 (26.67) 9 (30.00) 4 (13.33)
    IV级 10 (33.33) 9 (30.00) 8 (26.67)
    V级 5 (16.67) 3 (10.00) 2 (6.67)
    P < 0.05 vs A、B组.
    下载: 导出CSV
  • [1] Vitt JR, Sun CH, Le Roux PD, et al. Minimally invasive surgery for intracerebral hemorrhage[J]. Curr Opin Crit Care. 2020, 26(2): 129- 36. http://d.old.wanfangdata.com.cn/Periodical/zgnxgbzz201803005
    [2] Kellner CP, Song R, Troiani ZS, et al. Minimally invasive endoscopic evacuation of intracerebral haemorrhage: reaching the goal[J]. Lancet, 2020, 395(10218): e5-13.
    [3] Zhang JX, Lu SY, Wang SZ, et al. Comparison and analysis of the efficacy and safety of minimally invasive surgery and craniotomy in the treatment of hypertensive intracerebral hemorrhage[J]. Pak J Med Sci, 2018, 34(3): 578-82.
    [4] van Asch CJ, Luitse MJ, Rinkel GJ, et al. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis[J]. Lancet Neurol, 2010, 9(2): 167-76.
    [5] Liang KS, Ding J, Yin CB, et al. Clinical study on minimally invasive liquefaction and drainage of intracerebral hematoma in the treatment of hypertensive putamen hemorrhage[J]. Technol Health Care, 2017, 25(6): 1061-71. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=c24c25e8098688d78bc1cbd5e500dba0
    [6] Tang Y, Yin F, Fu D, et al. Efficacy and safety of minimal invasive surgery treatment in hypertensive intracerebral hemorrhage: a systematic review and meta-analysis[J]. BMC Neurol, 2018, 18(1): 136-42.
    [7] Ratre S, Yadav N, Parihar VS, et al. Endoscopic surgery of spontaneous basal ganglionic hemorrhage[J]. Neurol India, 2018, 66 (6): 1694-703. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=2fa2d7de13934f2cdb8f1dae1ca5ea9d
    [8] McNett M. A review of the predictive ability of glasgow coma scale scores in head-injured patients[J]. J Neurosci Nurs, 2007, 39(2): 68- 75.
    [9] Gui CJ, Gao YK, Hu D, et al. Neuroendoscopic minimally invasive surgery and small bone window craniotomy hematoma clearance in the treatment of hypertensive cerebral hemorrhage[J]. Pak J Med Sci, 2019, 35(2): 377-82.
    [10] Lu TS, An CL, Guan JY. Clinical experience of individual surgical therapy in hypertensive basal Ganglia hemorrhage[J]. J Neurosurg Sci, 2018, 62(2): 140-5.
    [11] He Y, Cai Z, Chen Y, et al. Role of S-100β in stroke[J]. Int J Neurosci, 2018, 128(12): 1180-7. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=HighWire000003118665
    [12] Fiorella D, Arthur A, Bain M, et al. Minimally invasive surgery for intracerebral and intraventricular hemorrhage: rationale, review of existing data and emerging technologies[J]. Stroke, 2016, 47(5): 1399-406.
    [13] Feng Y, He JQ, Liu B, et al. Endoscope-assisted keyhole technique for hypertensive cerebral hemorrhage in elderly patients: a randomized controlled study in 184 patients[J]. Turk Neurosurg, 2016, 26(1): 84-9.
    [14] Yamashiro S, Hitoshi Y, Yoshida A, et al. Effectiveness of endoscopic surgery for comatose patients with large supratentorial intracerebral hemorrhages[J]. Neurol Med Chir (Tokyo), 2015, 55(11): 819-23.
    [15] Wang WH, Hung YC, Hsu SP, et al. Endoscopic hematoma evacuation in patients with spontaneous supratentorial intracerebral hemorrhage[J]. J Chin MedAssoc, 2015, 78(2): 101-7. http://d.old.wanfangdata.com.cn/Periodical/zgwqxsjwkzz201507009
    [16] Zhang HZ, Li YP, Yan ZC, et al. Endoscopic evacuation of basal Ganglia hemorrhage via keyhole approach using an adjustable Cannula in comparison with craniotomy[J]. Biomed Res Int, 2014, 2014: 898762-9.
    [17] Sun SW, Li YP, Zhang HZ, et al. Neuroendoscopic surgery versus craniotomy for supratentorial hypertensive intracerebral hemorrhage: a systematic review and meta-analysis[J]. World Neurosurg, 2020, 134: 477-88.
    [18] Xu XH, Chen XL, Li FY, et al. Erratum. Effectiveness of endoscopic surgery for supratentorial hypertensive intracerebral hemorrhage: a comparison with craniotomy[J]. J Neurosurg, 2018, 128(2): 649-57.
    [19] Wang WJ, Zhou NQ, Wang C. Minimally invasive surgery for patients with hypertensive intracerebral hemorrhage with large hematoma volume: a retrospective study[J]. World Neurosurg, 2017, 105: 348-58.
    [20] Du B, Shan AJ, Peng YP, et al. A new modified neuroendoscope technology to remove severe intraventricular haematoma[J]. Brain Inj, 2018, 32(9): 1142-8.
    [21] Hu YZ, Wang JW, Luo BY. Epidemiological and clinical characteristics of 266 cases of intracerebral hemorrhage in Hangzhou, China[J]. J Zhejiang Univ Sci B, 2013, 14(6): 496-504.
    [22] Aronowski J, Zhao XR. Molecular pathophysiology of cerebral hemorrhage: secondary brain injury[J]. Stroke, 2011, 42(6): 1781-6. doi: 10.1161-STROKEAHA.110.596718/
    [23] Zhou Y, Wang YC, Wang J, et al. Inflammation in intracerebral hemorrhage: from mechanisms to clinical translation[J]. Prog Neurobiol, 2014, 115: 25-44.
    [24] Gross BA, Jankowitz BT, Friedlander RM. Cerebral intraparenchymal hemorrhage: a review[J]. J Am Med Assco, 2019, 321(13): 1295-303. http://d.old.wanfangdata.com.cn/NSTLQK/NSTL_QKJJ0211552223/
    [25] Wang J. Preclinical and clinical research on inflammation after intracerebral hemorrhage[J]. Prog Neurobiol, 2010, 92(4): 463-77. doi: 10.1016-j.pneurobio.2010.08.001/
    [26] Sakdejayont S, Pruphetkaew N, Chongphattararot P, et al. Serum S100β as a predictor of severity and outcomes for mixed subtype acute ischaemic stroke[J]. Singapore Med J, 2020, 75: 206-11.
    [27] Michetti F, Corvino V, Geloso M.C, et al. The S100B protein in biological fluids: more than a lifelong biomarker of brain distress. [J]. Neurochem, 2012, 120, 644-59.
    [28] Vos PE, Jacobs B, Andriessen TM, et al. GFAP and S100B are biomarkers of traumatic brain injury: an observational cohort study [J]. Neurology, 2010, 75(20): 1786-93.
    [29] James ML, Blessing R, Phillips- Bute BG, et al. S100B and brain natriuretic peptide predict functional neurological outcome after intracerebral haemorrhage[J]. Biomarkers, 2009, 14(6): 388-94. http://d.old.wanfangdata.com.cn/NSTLQK/NSTL_QKJJ0218605126/
    [30] Thelin EP, Nelson DW, Bellander BM. A review of the clinical utility of serum S100B protein levels in the assessment of traumatic brain injury[J].Acta Neurochir, 2017, 159(2): 209-25.
    [31] Goyal A, Failla MD, Niyonkuru C, et al. S100b as a prognostic biomarker in outcome prediction for patients with severe traumatic brain injury[J]. J Neurotrauma, 2013, 30(11): 946-57.
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  • 收稿日期:  2020-04-13
  • 刊出日期:  2020-04-15

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