不同神经内镜入路治疗基底节区高血压脑出血的对比研究

Comparative study of different neuroendoscopic approaches for the treatment of hypertensive intracerebral hemorrhage in the basal ganglia region

摘要:

目的 比较不同神经内镜入路治疗基底节区高血压脑出血（HICH）的效果。方法 回顾性分析 2020 年 4 月至 2024 年 4 月在东莞康华医院行神经内镜治疗的 162 例基底节区HICH患者的临床资料。根据神经内镜入路的不同 把患者分为A、B、C组，每组 54 例。A 组采用经外侧裂-岛叶入路，B组采用经额叶入路，C组采用经颞叶皮质入路。对 比 3 组的围手术期指标、脑部血流灌注指标、治疗期间并发症和预后。结果 A 、B组的血肿清除率明显高于C组，入住 神经重症监护病房（NICU）及住院时间均短于C组，且A组表现更显著，但A组的手术时间明显长于B、C组（P<0.01 或 0.05）。术后 1 d，3 组的局部脑血容量和局部脑血流量明显高于术前，对比剂平均通过时间则短于术前，且A组表现更显 著（P<0.01 或 0.05）。3 组术中并发症发生情况差异无统计学意义（P>0.05）。A组预后情况最好，其次是B组（P<0.0125）。 结论 经外侧裂-岛叶入路治疗HICH可提高血肿清除率、脑部血流灌注和预后情况，缩短入住NICU时间和住院时间， 但手术时间较长。

Abstract:

Objective The aim of this study is to investigate the value of different neuroendoscopic approaches for the treatment of hypertensive intracerebral hemorrhage (HICH）in the basal ganglia region. Methods Retrospective analysis of clinical data was conducted on 162 patients with HICH in the basal ganglia region who underwent neuroendoscopic treatment in Dongguan Kanghua Hospital from April 2020 to April 2024. The patients were divided into three groups (A, B, and C) based on the different endoscopic approaches, with 54 cases in each group. Group A was treated with translateral fissure-insula approach, Group B was treated with translateral frontal lobe approach, and Group C was treated with translateral temporal lobe cortex approach. The perioperative indicators, cerebral blood flow perfusion indicators, complications during treatment, and prognosis of three groups were compared. Results The clearance rate of hematoma in groups A and B was significantly higher than that in group C, and the length of stay in NICU and hospital was shorter than that in group C, and the performance in group A was more significant, but the operation time of group A was significantly longer than that of group B and C (P<0.01 or 0.05). On day 1 after operation, the local cerebral blood volume (rCBV) and regional cerebral blood flow (rCBF) in 3 groups were significantly higher than before operation, and the mean time to passage of contrast agent (MTT) was shorter than before operation, and the performance in group A was more significant (P<0.01 or 0.05). There was no significant difference in the occurrence of intraoperative complications among the three groups (P>0.05). Group A had the best prognosis, followed by group B (P<0.0125). Conclusion The translateral fissure-insula approach can improve hematoma clearance rate, cerebral blood flow perfusion, and therapeutic effect, shorten the time of admission to NICU and hospitalization, but the surgical time is long.