小骨窗开颅与经内镜“娩出法”在超早期壳核出血治疗中的临床效果比较

Comparison of clinical effects between small bone window craniotomy and endoscopic evacuation in the treatment of ultra-early putaminal hemorrhage

摘要:

目的 探讨小骨窗开颅与经内镜“娩出法”在超早期壳核出血治疗中的临床效果。方法 选取2020年4月—2024年4月佛山市第二人民医院、佛山市第一人民医院收治的61例超早期壳核出血患者。其中29例患者接受小骨窗开颅手术（小骨窗组），32例患者采用经内镜“娩出法”（经内镜组）。比较两组患者的手术时间、术中出血量、ICU留置时间、临床症状转归情况、格拉斯哥预后评分（GOS）、炎症因子及神经功能指标、术后并发症发生率，术后6个月通过改良Rankin量表（MRS）评估患者神经功能。结果 经内镜组手术时间、ICU留置时间均短于小骨窗组（P <0.05），术中出血量少于小骨窗组（P <0.05），MRS评分低于小骨窗组（P <0.05）。经内镜组颅内水肿持续时间、肢体活动好转时间和意识好转时间均短于小骨窗组（P <0.05），血肿清除率高于小骨窗组（P <0.05）。两组患者术后1、2和4周GOS评分比较，结果 ①不同时间点GOS评分比较，差异有统计学意义（P <0.05）；②两组患者GOS评分比较，差异有统计学意义（P <0.05），经内镜组GOS评分更高，相对恢复效果较好；③两组患者GOS评分变化趋势比较，差异有统计学意义（P <0.05）。经内镜组手术前后C反应蛋白、肿瘤坏死因子-α和神经元特异性烯醇化酶的差值均高于小骨窗组（P <0.05）。两组患者并发症总发生率比较，差异无统计学意义（P >0.05）。结论 在超早期壳核出血治疗中，经内镜“娩出法”相较于小骨窗开颅具有手术时间短、术中出血少、血肿清除率高的优势。

Abstract:

Objective To compare the clinical effects of small bone window craniotomy and endoscopic evacuation in treating ultra-early putaminal hemorrhage.Methods From April 2020 to April 2024, a total of 61 patients with ultra-early putaminal hemorrhage were enrolled from the Second People's Hospital of Foshan and the First People's Hospital of Foshan. Among them, 29 patients underwent craniotomy through a small bone window (small bone window group), while 32 patients were treated by endoscopic evacuation (endoscopic group). The two groups were compared in terms of operative duration, intraoperative blood loss, length of ICU stay, clinical symptom outcomes, Glasgow Outcome Scale (GOS) scores, inflammatory factors, neurological function indicators, incidence of postoperative complications, and neurological function 6 months after surgery as assessed by the Modified Rankin Scale (MRS).Results The operative duration and length of ICU stay were shorter (P < 0.05), intraoperative blood loss was less (P < 0.05), and the MRS score was lower (P < 0.05) in the endoscopic group compared with the small bone window group. The duration of cerebral edema, time to improvement in limb mobility, and time to consciousness improvement were shorter (P < 0.05), and the hematoma clearance rate was higher (P < 0.05) in the endoscopic group than in the small bone window group. The GOS scores at 1 week, 2 weeks and 4 weeks after surgery in the two groups of patients were compared via repeated measures ANOVA, which showed that they were different among the time points (P < 0.05) and between the groups (P < 0.05). The GOS scores in the endoscopic group were higher, indicating relatively better recovery outcomes. The change trends of the GOS scores were different between the two groups of patients (P < 0.05). The differences of the levels of C-reactive protein, tumor necrosis factor-α and neuron-specific enolase before and after surgery in the endoscopic group were greater than those in the small bone window group (P < 0.05). There was no difference in the overall incidence of complications between the two groups (P > 0.05).Conclusions In the management of ultra-early putaminal hemorrhage, the endoscopic evacuation offers advantages over small bone window craniotomy including shorter operative duration, reduced intraoperative bleeding, and improved hematoma clearance rates.