摘要： 目的 总结神经内镜用于脑室铸型血肿清除的技术要点和疗效。方法 纳入2019年1月至2021年5月在河南大学淮河医院行神经内镜下血肿清除术的36例脑出血患者，全脑室铸型12例、第三脑室和单侧侧脑室铸型15例、第三脑室和双侧侧脑室铸型9例。术中重型全脑室铸型患者平行矢状缝做小弧形切口（冠状缝前2/3、后1/3处），使切口位置较常规额角穿刺切口后移1 ~ 2 cm；以10 ml注射器自制内镜工作通道，精准定位，避免套筒方向及深度不断改变而损伤脑组织。据日常生活活动能力量表（ADL）和Glasgow预后分级（GOS）评价术后3个月时生活质量及预后。结果 平均手术时间1.50 h，32例血肿清除率> 90%、4例> 80% ~ 90%，CT显示无残留血肿、脑室系统恢复正常解剖形态，行腰大池持续引流28例、腰椎穿刺引流8例。术后14 d Glasgow昏迷量表（GCS）评分（11.63 ± 2.47）分，高于术前（9.82 ± 1.68）分（t = 3.162，P = 0.021），睁眼和运动功能明显改善。住院期间无死亡病例，术后3个月2例（5.56%）死于肺部感染，生存患者生活质量良好者占94.12%（32/34，ADL评分Ⅱ级18例、Ⅲ级14例），不良者5.88%（2/34，ADL评分Ⅳ级）；预后良好94.12%（32/34，GOS评分5分18例、4分14例），预后不良5.88%（2/34，GOS评分3分）。结论 神经内镜直视下可迅速清除脑室铸型血肿，缓解脑室压力，缩短患者恢复期，提高术后生活质量，值得临床推广应用。

关键词: 脑出血, 脑室, 引流术, 神经内窥镜检查

Abstract: Objective To summarize the technical points and curative effects of neuroendoscopy in the removal of ventricular casting hematoma.Methods A total of 36 patients with ventricular casting who underwent neuroendoscopy hematoma evacuation in Huaihe Hospital of He'nan University from January 2019 to May 2021 were included. Among them, 12 cases were whole ventricle casting, 15 cases were third ventricle and unilateral lateral ventricle casting, and 9 cases were the third ventricle and bilateral lateral ventricle casting. A small arc-shaped incision was made parallel to the sagittal suture in the case of heavy whole ventricle casting, which made the incision anterior 2/3 and posterior 1/3 of the coronal suture. Compared with the conventional frontal angle puncture incision, the incision was moved back by 1-2 cm. A 10 ml syringe was used to create a self-made endoscope working channel, precise positioning to avoid damage to brain tissue due to continuous changes in the direction and depth of the sleeve. At 3 months after surgery, the quality of daily life and prognosis of the patients were evaluated according to the Activities of Daily Living Scale (ADL) and Glasgow Outcome Scale (GOS).Results The average surgery time was 1.50 h. The hematoma clearance rate was > 90% in 32 cases and > 80%-90% in 4 cases. CT showed no residual hematoma, and the ventricular system returned to normal anatomical shape. Continuous lumbar drainage after surgery was undergone in 28 cases, while lumbar puncture and drainage was undergone in 8 cases. On the 14th day after surgery, the GCS score was 11.63 ± 2.47, which was higher than the preoperative score of 9.82 ± 1.68 (t = 3.162, P = 0.021), with significant improvement in eye opening and motor function. There were no deaths during hospitalization, and 2 patients died of pulmonary infection at 3 months after the surgery. Among the survival patients, 94.12% (32/34, 18 cases of ADL grade Ⅱ and 14 cases of grade Ⅲ, or 18 cases of GOS score 5 and 14 cases of GOS score 4) had good quality of life, 5.88% (2/34, ADL grade Ⅳ or GOS score 3) were not good.Conclusions Under the direct vision of neuroendoscopy, the ventricular casting hematoma can be quickly removed, which relieved the pressure of the ventricle, shorten the recovery period of patients, and improved the quality of life after surgery. It is worthy of clinical application.

Key words: Cerebral hemorrhage, Cerebral ventricles, Drainage, Neuroendoscopy