摘要
目的探讨神经内镜联合管状脑牵开器(ViewSite Brain Access System,VBAS)治疗基底节区脑出血的临床策略及疗效。方法回顾性分析2017年01月~2018年12月入院收治的47例神经内镜结合管状脑牵开器治疗的基底节区脑出血病人的临床资料,根据手术入路,分成A组31例(经额中回入路)和B组16例(经颞叶皮层入路),比较两组手术路径的距离、血肿清除率、手术时间、术中失血量、神经重症病房(NICU)住院时间以及手术并发症等。所有病例均随访6个月以上,比较两组术后2周的GCS评分及术后6个月的ADL评分。结果47例病人均安全手术,无死亡病例。A组手术路径距离长于B组,但血肿清除率、手术时间、术中失血量以及术区脑梗死情况等均优于B组,差异有统计学意义(P<0.05)。两组癫痫、颅内感染、术后再出血导致的二次手术率等并发症以及NICU住院时间等差异无统计学意义。A组术后2周GCS评分及术后6个月ADL评分较B组均显著提高(P<0.05)。结论神经内镜联合VBAS治疗基底节区脑出血,术野暴露良好,止血彻底,血肿清除满意,手术操作时间短,手术副损伤及术后并发症少,且经额叶皮层入路优势更明显,可作为基底节区的脑出血的重要方法之一。
Objective To investigate the strategies and effect of neuroendoscope and ViewSite Brain Access System(VBAS)in the treatment of basal ganglia hemorrhage.Methods 47 basal ganglia hemorrhage patients with the treatment of neuroendscope and VBAS,including 31 cases via transmidfrontal gyrus approach(Group A),16 cases via transtemporal gyrus approach(Group B),admitted in the neurosurgery department of the 901 st Hospital of the Joint Logistics Support Force of PLA from Jan.2017 to Dec.2018,were retrospectively analysised by comparing surgery path distance,hematoma clearance rate,operation time,intraoperative blood loss,perioperative complications,and total length of hospital stay.All cases were followed up for more than 6 months after surgery,and GCS score 2 weeks after surgery and activity of daily living scale(ADL)3 months after surgery were compared between two groups.Results All patients had undergone surgery by neuroendscope and VBAS,and no patient die.The intraoperative blood loss,the surgery time and the incidence of cerebral infarction of Group A was significantly less than that of Group B,the distance of operation approach was significantly longer than that of Group B,and the clearance rate of hematoma was significantly higher than that of Group B,the differences were statistically significant(P<0.05).The incidence of postoperative seizures,intracranial infection and bleeding-induced secondary surgery and the total length of hospital had no difference between two groups.The GCS score 2 weeks after operation and the ADL scale 6 months after operation of group A significantly increased than that of group B(P<0.05).Conclusion Neuroendoscopic minimally invasive surgery combined withVBAS for basal ganglia hemorrhage is more effective,which can improve the clearance rate of hematoma,shorten the operative time,reduce brain tissue damage and the incidence of postoperative complications,especially via transmidfrontal gyrus approach.
作者
张永明
赵鹏程
许少年
黄振山
丁俊
邓鹏程
施建
Zhang Yongming;Zhao Pengcheng;XU Shaonian(Department of Neurosurgery,Anhui No.2 Province People's Hospital,Hefei,230041,China)
出处
《立体定向和功能性神经外科杂志》
2020年第4期237-241,共5页
Chinese Journal of Stereotactic and Functional Neurosurgery
基金
安徽省重点研究与开发项目(编号:201904a07020108)
关键词
脑出血
神经内镜
小骨窗
管状脑牵开器
Cerebral hemorrhage
Basal ganglia hemorrhage
Neuroendoscopy
Small bone window
ViewSite Brain Access System(VBAS)
