摘要
目的观察小脑出血不同手术治疗方案的临床疗效。方法本研究为回顾性病例对照研究,收集2018年1月至2022年1月住院手术治疗的小脑出血患者60例,采用枕下骨瓣开颅清除血肿的20例患者设为开颅组;采用锁孔小骨窗入路清除血肿的20例患者设为锁孔组,采用软通道穿刺置管引流术清除血肿的20例患者设为穿刺组;观察3组患者手术时间、术中出血量、术后术区残余血肿量、术后术区再出血例数、术后并发症发生例数、住院天数、重症监护病房时间、术前术后7 d格拉斯哥昏迷评分(GCS)、美国国立卫生院卒中量表评分(NIHSS);术后6个月格拉斯哥预后评分(GOS)。结果3组患者术后7 d GCS、NIHSS评分较术前明显改善(P<0.05);开颅组和锁孔组明显优于穿刺组(P<0.05);锁孔组明显优于开颅组(P<0.05);3组患者术后6个月GOS评分差异无统计学意义(P>0.05)。穿刺组手术时间、术中出血量明显小于开颅组和锁孔组(P<0.05),锁孔组手术时间、术中出血量明显小于开颅组(P<0.05)。穿刺组术后术区残余血肿量、术后术区再出血例数明显多于开颅组和锁孔组(P<0.05)。锁孔组术后并发症发生例数明显小于穿刺组和开颅组(P<0.05)。锁孔组住院天数、症监护病房时间明显小于穿刺组和开颅组(P<0.05),开颅组住院天数、症监护病房时间小于穿刺组(P<0.05)。结论临床上要根据小脑出血患者的具体情况选择手术方式,条件允许的情况下优先选择锁孔小骨窗入路显微镜或内镜下清除血肿,近期疗效、住院天数和重症病房时间均优于骨瓣开颅和穿刺置管引流清除血肿。
Objective To study clinical effects of cerebellar hemorrhage by different surgical treatment.Methods From January 2018 to January 2022,a retrospective analysis method was adopted.60 cerbellar hemorrhage patients were choosed.Craniotomy group had 20 patients who accepted hematoma clearance by craniotomy through suboccipital bone flap,keyhole group had 20 patients who accepted hematoma clearance by keyhole through small bone window approach,puncture group had 20 patients who accepted hematoma clearance by soft channel puncture and catheter drainage.Operative time,the amount of intraoperative bleeding,the amount of postoperative residual hematoma in the operative area,the number of postoperative rebleeding,the amount of postoperative complications,hospitalization days and ICU time were observed.Glasgow coma scale(GCS),National Institutes of Health Stroke Scale(NIHSS)before and 7 days after surgery,and Glasgow Outcome Scale(GOS)after 6 months after surgery were recorded.Results GCS and NIHSS scores of 3 groups were significantly improved 7 days after surgery(P<0.05).Craniotomy group and keyhole group were better than puncture group(P<0.05).Keyhole group were better than craniotomy group(P<0.05).GOS scores of 3 groups had no difference(P>0.05).Operative time and intraoperative hemorrhage in puncture group was better than craniotomy group and keyhole group(P<0.05),which in keyhole group was better than craniotomy group(P<0.05).Postoperative residual hematoma and the number of postoperative rebleeding in puncture group were more than those in craniotomy group and keyhole group(P<0.05).The amount of postoperative complications in keyhole group was smaller than craniotomy group and puncture group(P<0.05).The hospitalization days and ICU time in keyhole group were fewer than craniotomy group and puncture group(P<0.05),which in craniotomy group was fewer than that in puncture group(P<0.05).Conclusion In clinical practice,surgical methods should be selected according to the specific conditions of patients with cerebellar hemorrhage.If conditions permit,it is preferred to clear the hematoma by keyhole through small bone window approach under neuroendoscope or microscope,short-term effects,hospitalization days and ICU time are better than craniotomy or puncture and catheter drainage.
作者
袁淼
翟安林
肖文峰
苟志勇
王帆
朱黎
Yuan Miao;Zhai Anlin;Xiao Wenfeng(Department of Neurosurgical,Mianyang 404 Hospital,the Second Affiliated Hospital of North Sichuan Medical College,Mianyang,Sichuan 621000,China)
出处
《四川医学》
CAS
2024年第7期765-769,共5页
Sichuan Medical Journal
关键词
小脑出血
清除血肿
开颅
锁孔
穿刺
cerebellar hemorrhage
hematoma clearance
craniotomy
keyhole
puncture
