摘要：

 目的 探讨神经内镜下血肿清除术在幕上高血压脑出血治疗中的应用价值。方法 选择2017年1月至2018年12月收治的56例幕上高血压脑出血患者，术前采用3D-Slicer软件+手机软件定位血肿，于内镜下行血肿清除术，术后CT观察血肿清除率、再出血、继发性脑水肿和吸入性肺炎等相关并发症，Glasgow预后分级评价预后、Barthel指数（BI）评价日常生活活动能力。结果 术后CT显示血肿清除率>85%，无一例出现继发性脑积水； 6例（10.71%）并发肺部感染、 1例（1.79%）发生再出血。术后8个月时，恢复良好11例（19.64%）、轻残27例（48.21%）、重残15例（26.79%）、植物状态生存3例（5.36%），无死亡病例；BI评分>60分30例（53.57%）、40~60分8例（14.29%）、20~40分15例（26.79%）、 0分3例 （5.36%）。结论 神经内镜下血肿清除术治疗幕上高血压脑出血操作简便、可复制性强、创伤小、并发症 发生率低、所需设备易获得，适合在基层医院推广应用。

关键词:  颅内出血, 高血压性, 内窥镜检查, 神经外科手术

Abstract:

 Objective To explore the value of neuroendoscopic approach for hematoma evacuation in the treatment of supratentorial hypertensive cerebral hemorrhage. Methods From January 2017 to December 2018, a total of 56 patients with supratentorial hypertensive cerebral hemorrhage were studied. Using of 3D-Slicer software and mobile phone software to locate the hematoma site. Hematoma evacuation was performed under neuroendoscopic approach. After operation, hematoma clearance rate and rebleeding, secondary cerebral edema and the related complications such as aspiration pneumonia were observed by CT. Glasgow Outcome Scale (GOS) was used to evaluate prognosis, Barthel Index (BI) was used to evaluate activities of daily living, and the incidence of complications such as pulmonary infection and rebleeding was recorded. Results All of the 56 patients successfully completed the neuroendoscopic approach operation. Hematoma clearance rate was > 85% . There was no secondary hydrocephalus occurred. Six patients (10.71%) developed pulmonary infection, one patient (1.79%) occurred rebleeding. After an average follow-up of 8 months, 11 cases (19.64%) recovered well; 27 cases (48.21%) lightly disabled; 15 cases (26.79%) severely disabled; and 3 cases (5.36% ) were living in vegetative state; and there were no death. In BI scores, 30 cases > 60, 8 cases were 40-60, 15 cases were 20-40, 3 cases were 0. Conclusions The neuroendoscopic surgery approach for treatment of supratentorial cerebral hemorrhage is simple, easy to operate with less damage and lower incidence of complications. The required equipments are simple and more suitable for basic-level hospital.

Key words:  Intracranial hemorrhage, hypertensive, Endoscopy, Neurosurgical procedures