史强

[摘要] 目的 探讨小骨瓣经侧颞入路高血压脑出血手术治疗临床效果。方法 方便选取该院2015年8月—2017年8月收治的80例慕上高血压脑出血患者，以随机数表法分成观察组与对照组各40例。观察组患者接受神经内镜微创手术治疗;对照组患者接受小骨窗开颅显微手术治疗。对比两组患者手术基本情况、入住ICU时间及术后感染率情况。结果 观察组患者手术时间、术中出血量及血肿清除率分别为（1.5±1.1）h、（41.0±20.5）mL、（90.0±9.5）%;对照组分别为（3.5±1.3）h、（349.8±110.5）mL、（75.8±15.6）%，两组患者手术时间、术中出血量及血肿清除率对比差异有统计学意义（t=7.428、17.378、4.917，P<0.05）;观察组患者术后入住ICU时间和感染率分别为（7.2±2.0）d、2.5%（1/40）;对照组分别为（13.2±3.5）d、25.0%（10/40），两组患者术后入住ICU时间和感染率对比差异有统计学意义（t=9.414，χ2=8.538，P<0.05）。 结论 神经内镜微创手术与小骨窗开颅显微手术治疗幕上高血压脑出血均有效，但前者临床效果更显著，更值得临床推广。

[关键词] 神经内镜微创手术;小骨窗开颅显微手术;幕上高血压脑出血;临床效果

[中图分类号] R5          [文献标识码] A          [文章編号] 1674-0742（2018）08（c）-0046-03

Minimally Invasive Surgery and Mini-Bone Craniotomy for the Treatment of Hypertensive Intracerebral Hemorrhage

SHI Qiang

Department of Neurosurgery， Xintai People's Hospital， Xintai， Shandong Province， 271200 China

[Abstract] Objective To investigate the clinical effect of surgical treatment of hypertensive intracerebral hemorrhage through the lateral sacral approach. Methods 80 patients with Mushang hypertensive intracerebral hemorrhage who were admitted to the hospital from August 2015 to August 2017 were convenient selected and divided into observation group and control group with 40 cases each. The patients in the observation group underwent minimally invasive endoscopic surgery; the patients in the control group underwent microsurgery with a small bone window craniotomy. The basic situation of surgery， the time of ICU admission， and the postoperative infection rate were compared between the two groups. Results The operative time， intraoperative blood loss， and hematoma clearance rate in the observation group were （1.5±1.1）h，（41.0±20.5）mL，（90.0±9.5）%， and （3.5±1.3）h， （349.8±110.5）mL， （75.8±15.6）% in the control group， respectively. There was a statistically significant difference in the operation time， blood loss， and hematoma clearance between the two groups（t=7.428， 17.378， 4.917， P<0.05）; The time and infection rate of ICU after admission was （7.2±2.0）d and 2.5%（1/40）， and that of the control group was （13.2±3.5）d and 25.0% （10/40） respectively. There was a statistically significant difference between time and infection rate（t=9.414， χ2=8.538， P<0.05）. Conclusion Neuroendoscopic minimally invasive surgery and craniotomy of small bone windows are effective for the treatment of supratentorial hypertensive intracerebral hemorrhage. However， the clinical effect of the former is more significant and worthy of clinical promotion.

[Key words] Neuroendoscope minimally invasive surgery; Small bone window craniotomy microsurgery; supratentorial hypertensive cerebral hemorrhage; Clinical effect

高血压脑出血为高血压严重并发症，患者常因该症而引发颅内小动脉病变，随着病情不断加重，风险程度也不断增加，必须予以及早治疗，否则患者极易死亡[1]。手术是治疗高血压脑出血最常用的方式，其能有效消除血肿，促使神经功能的恢复，改善患者预后。以往小骨窗开颅显微手术治疗高血压脑出血最為常用，但临床效果不理想，加之微创手术技术不断成熟，其成功治疗高血压脑出血的案例也是屡见不鲜[2-3]。为此，该次该院方便选取2015年8月—2017年8月收治的80例幕上高血压脑出血患者作为研究对象，分组后分别实施小骨窗开颅微创手术和神经内镜微创手术，以探讨两种手术方式治疗幕上高血压脑出血的临床差异性，并对结果作系统分析，现报道如下。……