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

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

昆明市第一人民医院神经外科，云南昆明 650000

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

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出版历程
- 收稿日期: 2020-04-13
- 刊出日期: 2020-04-15

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

Department of Neyrosurgery, Kunming First People's Hospital, Kunming 650000, China

摘要

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。
- 神经内镜手术 /
- 高血压脑出血 /
- 颅骨钻孔+尿激酶输注+导管引流术 /
- 小骨窗开颅术 /
- 血肿
Abstract: ObjectiveTo compare and evaluate the efficacy and safety of the neuroendoscopic surgery with the small bone window craniotomy and the burr hole, urokinase infusion, and catheter drainage for the treatment of evacuation in the hematoma of HICH patients.MethodsA total of 90 patients with HICH were randomized into three groups. Group A: underwentsmall bone window craniotomy (n=30). Group B: underwentburr hole + urokinase infusion + catheter drainage surgery (n=30). Group C: underwent neuroendoscopic surgery (n=30). The hematoma evacuation rate, mortality rate, glasgow coma scale (GCS), glasgow outcome score (GOS), and complications including rebleeding, pneumonia, and intracranial infection were compared in the three groups. The levels of IL4, IL6, IL8, IL10 and serum S100β protein in the peripheral blood of all HICH patients were determined by ELISA method.ResultsAll surgical approaches were successfully performed. The hematoma evacuation percentage was significantly different in the three groups, which were 74.5%, 43.1% and 88.2%, respectively (P < 0.05). Operation time, rebleeding rate, pneumonia rate, and mortality rate in Group C was lower than Group A and Group B, respectively (P < 0.05).The GOS score 6 months after the surgical approach showed that the number of Grade I and Grade II in Group C was significantly higherthan that in Group A and B (P < 0.05), while the number of Grade III, Grade IV and Grade V in Group C was significantly lower than Group A and B (P < 0.05). The postoperative IL10 level of patients in Group C were elevated and significantly higher than that in Group A and Group B at 72 hours, while the IL-4, IL-6 andIL-8 were decreased and significantly lower than that in Group A and B. The level of S100β in Group C was significantly lower than that in Group A and B at 28 days after operation (P < 0.05).ConclusionNeuroendoscopic technical has minimal invasive, direct vision, higher hematoma evacuation rate, lower incidence rate of complications, and significant improvement of clinical outcomes. It might be a more promising approach for the treatment of HICH.
- small bone window craniotomy /
- burr hole+urokinase infusion+catheter drainage surgery /
- hematoma /
- hypertensive intracerebral hemorrhage /
- neuroeendoscopic surgery

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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

下载: 全尺寸图片幻灯片

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

下载: 全尺寸图片幻灯片

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

下载: 全尺寸图片幻灯片

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

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