临床神经外科投稿修正稿2013-04-07.docVIP

神经内镜锁孔入路与传统开颅术治疗颅内血肿的对比研究 佘磊 李育平 张恒柱* 严正村 王晓东 董伦 张楠 （ 扬州大学临床医学院 神经外科 225001） 【摘要】目的：目前神经内镜治疗颅内血肿仍存在争议，本研究旨在评价神经内镜锁孔入路清除颅内血肿的临床疗效及安全性。方法:回顾性分析21例颅内出血患者采用神经内镜治疗的临床资料，另随机选择同期30例采用传统开颅血肿清除术治疗颅内血肿患者作为对照组。以死亡率、血肿量, 血肿清除率、感染率、GCS评分、mRS评分、GOS评分等作为判效指标。结果: 神经内镜组血肿清除率明显高于传统手术治疗组，两组差异具有明显统计学意义(P=0.02), 且神经内镜组术后感染率低于对照组 (P=0.04)。两组在死亡率(P=0.27)、GOS评分 (P=0.07) 、出院时GCS评分(P=0.08)、6个月mRS 评分(P=0.49)方面差异均无统计学意义。而神经内镜组患者术后恢复良好率(GOS≥4)明显高于对照组，差异具有统计学意义(P=0.04)。结论:神经内镜经锁孔入路治疗颅内血肿临床疗效满意，具有较高的血肿清除率，明显降低术后感染发生率，显著提高患者术后的神经功能恢复。 【关键词】 神经内镜, 颅内血肿, 锁孔入路, 血肿清除 ? Intracerebral Hemorrhages：a comparative study of neuroendoscopic surgery via keyhole versus craniotomy approach SHE Lei， LI Yu-ping， ZHANG Heng-zhu，et.al. Department of Neurosurgery, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu Province, (225001), China ABSTRACT: Objective Using neuroendoscopy as a treatment for intracerebral hemorrhage is controversial. This research aims to evaluate the usefulness of the neuroendoscopic approach without sheath to treat intracerebral hemorrhage (ICH), comparing the results to a craniotomy treatment approach. Methods Clinical data of 21 cases of ICH by neuroendoscopic therapy were analyzed retrospectively, and 30 cases of ICH treated with craniotomy approach were used as a control group. The clinical and radiographical outcomes included the mortality rate, hematoma volume, hematoma evacuation rates, infection rates, Glasgow Coma Scale (GCS) scores on admission, the third postoperative day, and at discharge, Modified Rankin Scale (mRS) on admission, at discharge, and during follow-up examinations conducted at 6 months post-surgery, and Glasgow Outcome Scale (GOS) scores at discharge and follow-up examinations. Results The hematoma evacuation rate was significantly higher in the neuroendoscopy group compared to the craniotomy group (P=0.02), and the rate of infection was lower in the neuroendoscopy group compared to the craniotomy (P=0.04). Mortality rates between the 2 groups di