微创医学

目的分析神经内镜下不同手术入路在颅内血肿患者中的应用效果。方法选取160例急性高血压脑出血颅内血肿患者，随机将其分为锁孔入路组和鼻蝶入路组，各80例。比较两组患者在接受不同入路神经内镜手术后的手术相关指标、近期疗效，以及患者出院时、出院后6个月的改良Rankin量表（mRS）评分、格拉斯哥昏迷量表（GCS）评分及出院后6个月的日常生活能力（ADL）评级。结果鼻蝶入路组患者术中出血量显著少于锁孔入路组(P＜0.05)，但两组手术时间比较，差异无统计学意义(P＞0.05)。两组血肿清除率、死亡率差异无统计学意义(均P＞0.05)。鼻蝶入路组患者平均住院时间和术后感染率显著短/低于锁孔入路组(均P＜0.05)。出院后6个月，两组患者mRS评分均较出院时降低，GCS评分均较出院时升高 (均P＜0.05)；出院后6个月，两组间GCS评分差异无统计学意义(P＞0.05)，而鼻蝶入路组mRS评分显著低于锁孔入路组(P＜0.05)。出院后6个月，两组患者死亡率和恢复良好率比较差异无统计学意义(均P＞0.05)；在ADL评级中，鼻蝶入路组Ⅰ级恢复率显著优于锁孔入路组患者(P＜0.05)。结论在颅内血肿患者中采用神经内镜下锁孔入路和鼻蝶入路手术都具有较好的治疗效果和预后，而经鼻蝶入路可以显著降低术后感染率并增加ADL评级Ⅰ级的占比，可以优先考虑使用。

ObjectiveTo analyze the application effects of different operative approaches via neuroendoscopy in patients with intracranial hematoma. MethodsA total of 160 patients with acute hypertensive cerebral hemorrhage intracranial hematoma were enrolled and randomly assigned to keyhole approach group and endonasal transsphenoidal approach group, with 80 cases in each group. The operative related indicators and short-term efficacy after receiving different approaches via neuroendoscopy operations, and the modified Rankin scale (mRS) scores, Glasgow coma scale (GCS) scores during the discharge and 6 months after discharge, as well as the activities of daily living (ADL) grades 6 months after discharge were compared between the two groups. ResultsThe endonasal transsphenoidal approach group yielded less volume of intraoperative blood bleeding as compared with the keyhole approach group (P＜0.05); however, there was no statistically significant difference of operation duration between the two groups (P＞0.05). There were no statistically significant differences in hematoma clearance rate and death rate between the two groups (all P＞0.05). Compared to the keyhole approach group, the endonasal transsphenoidal approach group yielded shorter/lower mean hospital stays and postoperative infection rate (all P＜0.05). After 6 months of discharge, mRS scores decreased while GCS scores increased compared to discharge in the two groups (all P＜0.05). There was no statistically significant difference of GCS score between the two groups 6 months after discharge (P＞0.05), whereas mRS score was significantly lower in the endonasal transsphenoidal approach group than in the keyhole approach group (P＜0.05). After 6 months of discharge, there were no statistically significant differences in death rate and good recovery rate between the two groups (all P＞0.05). In the grades of ADL, the endonasal transsphenoidal approach group yielded superior rate of recovery in grade Ⅰ compared to the keyhole approach group (P＜0.05). ConclusionEmploying keyhole and endonasal transsphenoidal approaches in patients with intracranial hematoma have preferable efficacy and prognosis; however, the approach of endonasal transsphenoidal can prominently decrease the postoperative infection rate, and increase the proportion of grade Ⅰ in ADL grades, and thus it can be used preferentially.