Efficacy of neuroendoscopic surgery and craniotomy for spontaneous supratentorial intracerebral hemorrhage

doi:10.3969/j.issn.1672-6731.2024.11.013

Abstract

Abstract:

Objective: To investigate and compare the efficacy of neuroendoscopic surgery and craniotomy for spontaneous supratentorial intracerebral hemorrhage. Methods: A total of 65 patients with spontaneous supratentorial intracerebral hemorrhage who were admitted in Dongguan People's Hospital in Guangdong, received neuroendoscopic hematoma evacuation (n=19) or craniotomy hematoma evacuation (n=46) from December 2019 to December 2020.The hematoma clearance rate, rebleeding rate, operation time, intraoperative blood loss, postoperative intensive care unit (ICU) length of stay, postoperative tracheotomy rate and 30 d postoperative mortality were recorded.Glasgow Coma Scale (GCS) 7 d after surgery was used to evaluated the conscious, and modified Rankin Scale (mRS) 3 months after surgery was used to assess the neurological functional prognosis. Results: The hematoma clearance rate (t=2.393, P=0.020) and GCS score 7 d after surgery (t=3.445, P=0.001) in the neuroendoscopy group were higher than those in the craniotomy group, while the operation time (t=-13.318, P=0.000), intraoperative blood loss (t=-7.823, P=0.000), postoperative ICU length of stay (t=-4.183, P=0.000), postoperative tracheotomy rate (χ²=5.277, P=0.022), and mRS score 3 months after surgery (t=-2.493, P=0.015) were lower than those in craniotomy group. Conclusions: Neuroendoscopic surgery offers a higher hematoma clearance rate, less intraoperative blood loss, a shorter operation time and postoperative ICU length of stay, a lower postoperative tracheotomy rate, and improved postoperative conscious and neurological function prognosis, making it appropriate for clinical use.

Key words: Cerebral hemorrhage, Neuroendoscopy, Craniotomy

摘要：

目的: 对比分析神经内镜手术与开颅血肿清除术治疗自发性幕上脑出血的疗效。方法: 纳入2019年12月至2020年12月广东省东莞市人民医院诊断与治疗的65例自发性幕上脑出血患者，分别行神经内镜下血肿清除术（内镜组，19例）和开颅血肿清除术（开颅组，46例），记录血肿清除率、再出血率、手术时间、术中出血量、术后重症监护病房（ICU）住院时间、术后气管切开率和术后30 d病死率，术后7 d采用Glasgow昏迷量表（GCS）评估意识状态，术后3个月采用改良Rankin量表（mRS）评估神经功能预后。结果: 内镜组患者血肿清除率（t=2.393，P=0.020）和术后7 d GCS评分（t=3.445，P=0.001）高于开颅组，手术时间（t=-13.318，P=0.000）、术中出血量（t=-7.823，P=0.000）、术后ICU住院时间（t=-4.183，P=0.000）、术后气管切开率（χ²=5.277，P=0.022）和术后3个月mRS评分（t=-2.493，P=0.015）低于开颅组。结论: 神经内镜手术的血肿清除率更高，术中出血量更少，手术时间和术后ICU住院时间更短，术后气管切开率更低，术后意识状态和神经功能预后更佳，值得临床尝试应用。

关键词: 脑出血, 神经内窥镜检查, 颅骨切开术

Cheng-huan LUO, Bin TANG, Ze-ju YE, Jian-ping QIN, Xiao-hong LIU. Efficacy of neuroendoscopic surgery and craniotomy for spontaneous supratentorial intracerebral hemorrhage[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2024, 24(11): 962-967.

罗成焕, 唐斌, 叶泽驹, 覃建平, 刘小红. 自发性幕上脑出血神经内镜手术与开颅血肿清除术疗效对比分析[J]. 中国现代神经疾病杂志, 2024, 24(11): 962-967.

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References 21

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观察指标	内镜组（n = 19）	开颅组（n = 46）	统计量值	P值
性别[例（%）]			0.000*	0.996
男性	16（16/19）	37（80.43）
女性	3（3/19）	9（19.57）
年龄（$\bar x \pm s$，岁）	52.21± 11.86	53.00 ±7.98	- 0.266	0.792
发病至手术时间[M（P₂₅，P₇₅），h]	5.00（3.00，28.00）	4.00（3.00，8.50）	- 0.823	0.410
高血压[例（%）]	15（15/19）	42（91.30）	0.930	0.335
收缩压（$\bar x \pm s$，mm Hg）	174.37±32.62	178.63 ± 27.42	- 0.539	0.592
舒张压（$\bar x \pm s$，mm Hg）	102.32±21.07	105.91 ± 17.34	- 0.714	0.478
入院时GCS（$\bar x \pm s$，评分）	7.89±1.63	8.07 ±2.43	- 0.329	0.744
出血部位[例（%）]			0.006*	0.940
基底节区	14（14/19）	36（78.26）
皮质下	5（5/19）	10（21.74）
血肿量（$\bar x \pm s$，ml）	70.22±30.13	67.83 ± 22.50	0.352	0.726

观察指标	内镜组（n = 19）	开颅组（n = 46）	统计量值	P值
性别[例（%）]			0.000*	0.996
男性	16（16/19）	37（80.43）
女性	3（3/19）	9（19.57）
年龄（$\bar x \pm s$，岁）	52.21± 11.86	53.00 ±7.98	- 0.266	0.792
发病至手术时间[M（P₂₅，P₇₅），h]	5.00（3.00，28.00）	4.00（3.00，8.50）	- 0.823	0.410
高血压[例（%）]	15（15/19）	42（91.30）	0.930	0.335
收缩压（$\bar x \pm s$，mm Hg）	174.37±32.62	178.63 ± 27.42	- 0.539	0.592
舒张压（$\bar x \pm s$，mm Hg）	102.32±21.07	105.91 ± 17.34	- 0.714	0.478
入院时GCS（$\bar x \pm s$，评分）	7.89±1.63	8.07 ±2.43	- 0.329	0.744
出血部位[例（%）]			0.006*	0.940
基底节区	14（14/19）	36（78.26）
皮质下	5（5/19）	10（21.74）
血肿量（$\bar x \pm s$，ml）	70.22±30.13	67.83 ± 22.50	0.352	0.726

观察指标	内镜组（n = 19）	开颅组（n = 46）	t或χ²值	P值
血肿清除率（$\bar x \pm s$，%）	90.04±4.19	81.44± 23.50	2.393	0.020
再出血[例（%）]	1（1/19）	4（8.70）	—	1.000
手术时间（$\bar x \pm s$，min）	91.05± 25.36	257.37± 74.94	- 13.318	0.000
术中出血量（$\bar x \pm s$，ml）	96.32± 28.72	295.65± 166.94	- 7.823	0.000
术后ICU住院时间（$\bar x \pm s$，d）	5.95±1.93	9.83± 5.53	- 4.183	0.000
术后气管切开[例（%）]	3（3/19）	22（47.83）	5.277	0.022
术后7 d GCS（$\bar x \pm s$，评分）	11.37±2.11	9.37± 2.13	3.445	0.001
术后30 d死亡[例（%）]	1（1/19）	7（15.22）	0.484*	0.486
术后3个月mRS（$\bar x \pm s$，评分）	2.95±1.58	3.96± 1.44	- 2.493	0.015

观察指标	内镜组（n = 19）	开颅组（n = 46）	t或χ²值	P值
血肿清除率（$\bar x \pm s$，%）	90.04±4.19	81.44± 23.50	2.393	0.020
再出血[例（%）]	1（1/19）	4（8.70）	—	1.000
手术时间（$\bar x \pm s$，min）	91.05± 25.36	257.37± 74.94	- 13.318	0.000
术中出血量（$\bar x \pm s$，ml）	96.32± 28.72	295.65± 166.94	- 7.823	0.000
术后ICU住院时间（$\bar x \pm s$，d）	5.95±1.93	9.83± 5.53	- 4.183	0.000
术后气管切开[例（%）]	3（3/19）	22（47.83）	5.277	0.022
术后7 d GCS（$\bar x \pm s$，评分）	11.37±2.11	9.37± 2.13	3.445	0.001
术后30 d死亡[例（%）]	1（1/19）	7（15.22）	0.484*	0.486
术后3个月mRS（$\bar x \pm s$，评分）	2.95±1.58	3.96± 1.44	- 2.493	0.015

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