内镜辅助下长轴入路血肿清除术治疗中等量幕上自发性脑出血的临床研究

Clinical efficacy of endoscopic hematoma evacuation via along-the-long-axis approach in treatment of moderate supratentorial spontaneous intracerebral hemorrhage

摘要:

目的 探讨内镜辅助下长轴入路血肿清除术治疗中等量幕上自发性脑出血（SICH）的临床效果。方法 选取2018年7月—2022年9月宜兴市人民医院收治的75例中等量幕上SICH患者，根据入路方式不同分为研究组（39例）与对照组（36例）。对照组接受内镜辅助下非长轴入路血肿清除术（经颞顶入路），研究组接受内镜辅助下长轴入路血肿清除术（经眶上锁孔长轴入路）。对比两组手术相关指标、日常生活能力、神经功能、并发症、预后及经济学指标。结果 研究组血肿清除率高于对照组（P <0.05），手术时间短于对照组（P <0.05），术中出血量低于对照组（P <0.05）。两组手术前后的日常生活活动能力量表（ADL）评分差值、美国国立卫生研究院卒中量表（NHISS）评分差值比较，差异均无统计学意义（P >0.05）。研究组术后再出血、肺部感染发生率均低于对照组（P <0.05）；两组颅内感染、下肢静脉血栓形成、消化道出血发生率比较，差异均无统计学意义（P >0.05）。两组预后良好率比较，差异无统计学意义（P >0.05）。研究组住院费用低于对照组（P <0.05），总住院时间和ICU住院时间均短于对照组（P <0.05）。结论 相比于内镜辅助下非长轴入路血肿清除术，内镜辅助下长轴入路血肿清除术治疗中等量幕上SICH患者效果确切，可降低术后再出血、肺部感染发生风险，提高血肿清除率，减轻患者经济负担与手术创伤，并缩短手术时间及住院时间。

Abstract:

Objective To investigate the clinical efficacy of endoscopic hematoma evacuation via along-the-long-axis approach in treatment of moderate supratentorial spontaneous intracerebral hemorrhage (SICH).Methods The 75 patients with supratentorial SICH treated in Yixing People's Hospital from July 2018 to September 2022 were selected and divided into the study group (n = 39) and the control group (n = 36) according to different surgery approaches. The control group underwent endoscopic hematoma evacuation via the non-along-the-long-axis approach (trans-temporoparietal), while the study group underwent endoscopic hematoma evacuation via the along-the-long-axis approach (along the long axis of supraorbital keyhole). The surgical-related indicators, activity of daily living, neurological function, complications, prognosis and economic indicators were compared between the two groups.Results The hematoma clearance rate in the study group was higher than that in the control group (P < 0.05). The operative duration in the study group was shorter than that in the control group (P < 0.05). The intraoperative blood loss in the study group was less than that in the control group (P < 0.05). The differences of Activity of Daily Living (ADL) Scale scores and National Institutes of Health Stroke Scale (NHISS) scores before and after the surgery were not different between the two groups (P > 0.05). The incidence of postoperative rebleeding and pulmonary infection in the study group was lower than that in the control group (P < 0.05). There was no difference in the incidence of intracranial infection, lower limb venous thrombosis and gastrointestinal hemorrhage between the two groups (P > 0.05). There was no difference in the rate of good prognosis between the two groups (P > 0.05). The hospitalization cost of the study group was lower than that of the control group (P < 0.05), and the total length of hospital stay and ICU stay of the study group was shorter than that of the control group (P < 0.05).Conclusions Compared with endoscopic hematoma evacuation via the non-along-the-long-axis approach, endoscopic hematoma evacuation via the along-the-long-axis approach is effective in the treatment of patients with moderate supratentorial SICH. It reduces the risk of postoperative rebleeding and pulmonary infection, increases the hematoma clearance rate, reduces the financial burden and surgical trauma, and shortens the operative duration and the length of hospital stays.