摘要
目的探讨联合手术入路在自发性幕上脑出血治疗中的应用。方法对2018年12月-2022年11月本院神经外科收治并采用联合手术入路治疗的134例自发性幕上脑出血患者的临床资料进行回顾性分析,根据患者术前有无明显脑疝情况将手术方式分为2组,对无明显脑疝患者采用“钻孔引流+神经内镜”的联合入路(A组,117例);对有明显脑疝患者采用“钻孔引流+神经内镜+去骨瓣减压”联合入路(B组,17例)。结果所有手术均获得成功,A组患者平均血肿清除率约91.01%,出院格拉斯哥昏迷评分(Glasgow coma scale,GCS)评分(13.1±3.7)分;B组17例患者中死亡3例,放弃7例,病情好转5例,临床治愈2例,预后不良(死亡+放弃)率为58.8%。结论联合手术入路实现了三种手术方式优缺点的互补,且其安全性及有效性得到临床验证,是自发性幕上脑出血外科治疗的一种有益尝试。
Objective To explore the application of combined surgical approach in the treatment of spontaneous supratentorial cerebral hemorrhage.Methods The clinical data of 134 patients with spontaneous supratentorial intracerebral hemorrhage admitted to our hospital from 2018.12 to 2022.11 and treated by combined surgical approach were retrospectively analyzed.The patients were divided into two groups according to whether there was obvious cerebral hernia before operation.We used the combined approach of“drilling and drainage+neuroendoscope”for no obvious brain hernia(group A,117 cases).For patients with obvious cerebral hernia,we adopted the combined approach of“drilling drainage+neuroendoscope+decompressive craniectomy”(group B,17 cases).The basic clinical data,clinical prognosis and postoperative complications of the two groups were analyzed.Results All surgeries were successful,the average hematoma clearance rate of group A patients was about 92.01%,and the discharge GCS score was 13.1±3.7 points.Among the 17 patients in group B,3 died,7 gave up,5 improved and 2 were clinically cured.The rate of poor prognosis(death+abandonment)was 58.8%.Conclusion The combined surgical approach complements the advantages and disadvantages of the three surgical methods,and its safety and efficacy have been clinically verified,which is a promising attempt for the treatment of spontaneous supratentorial cerebral hemorrhage.
作者
魏航宇
蔡强
李知阳
宋平
周龙
雷盼
高论
程利
华秋伟
Wei Hangyu;Cai Qiang;Li Zhiyang(Department of Neurosurgery,Renmin Hospital of Wuhan University,Wuhan 430060)
出处
《卒中与神经疾病》
2023年第3期283-288,共6页
Stroke and Nervous Diseases
基金
国家自然科学基金项目(82271518、81971158、81671306)。
关键词
自发性幕上脑出血
神经内镜
联合手术入路
Spontaneous supratentorial intracerebral hemorrhage
Neuroendoscopy
Combined surgical approach
