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- Title
高血压性脑叶出血微创外科治疗的随机对照试验研究.
- Authors
李乾锋; 段发亮; 闵强; 罗明; 王春燕; 罗志华
- Abstract
Objective To compare the therapeutic efficacy of three types of minimally invasive procedures on hypertensive lobar hemorrhage. Methods According to the different preoperative hematoma volume, 120 patients with hypertensive lobar hemorrhage were divided into the large hematoma group and the small hematoma group, with 60 patients in each group. According to the random envelope method, each group was subdivided into the small bone window group (small bone window craniotomy assisted by neuronavigation for hematoma removal), the drilling group (hematoma cavity drainage assisted by neuronavigation) and the endoscopic group (neuroendoscopic hematoma removal assisted by neuronavigation), with 20 patients in each group. The following data of patients in each group were compared, including basic data, intraoperative data (operation time, intraoperative blood loss), postoperative data, hematoma clearance rates at 6 h, 3 d and 7 d after operation, Glasgow coma index score (GCS) at 6 h, 3 d and 7 d after operation, postoperative complications (tracheotomy, intracranial infection, recurrent bleeding), drainage tube retention time and drug injection time, prognosis data, Glasgow prognosis score (GOS) at 3 months after operation. Results There were no significant differences in age, preoperative hematoma volume, bleeding location, onset to operation time and preoperative GCS score between the large hematoma group and the small hematoma group (P>0.05). In the large hematoma group and the small hematoma group, compared with the small bone window group and the endoscopic group, the drilling group had the shortest operation time, the least intraoperative blood loss, and the hematoma clearance rate was reduced at 6 h and 3 d after surgery, and the drainage tube retention time was prolonged (P<0.05). There were no significant differences in complications between the three groups. In the large hematoma group, the GCS score was higher at 6 h after surgery in the endoscopic group than that of the drilling group, and the GCS score was higher at 3 d and 7 d after surgery in the endoscopic group than that of the small bone window group and the drilling group (P<0.05). In the large hematoma group, the average injection time was longer in the drilling group than that of the small hematoma group (P<0.05). In the large hematoma group, the favorable prognostic rate was higher in the endoscopic group than that of the small bone window group and the drilling group (P<0.05), while there was no significant difference in the favorable prognostic rate between the three subgroups of the small hematoma group (P> 0.05). Conclusion Hematoma cavity catheterization and drainage can shorten the operation time and reduce the intraoperative blood loss. Both neuroendoscopy and small bone window craniotomy have higher hematoma clearance rates.
- Publication
Tianjin Medical Journal, 2022, Vol 50, Issue 10, p1072
- ISSN
0253-9896
- Publication type
Article
- DOI
10.11958/20220338