常规开颅手术和脑室镜治疗硬膜下血肿的对比研究

目的:对比分析常规开颅手术和脑室镜治疗硬膜下血肿的临床疗效。方法:自2012年1月到2013年10月,我科急诊收治的硬膜下血肿病例共63例。其中脑室镜组28例,男16例,女12例,年龄(33.2±9.4)岁;常规开颅组35例,男23例,女12例,年龄30.2±9.4岁。常规开颅组采用传统的大骨瓣开颅术清除颅内血肿,另一组采用脑室镜微创技术清除颅内血肿。结果:脑室镜组和常规开颅组的术前GCS评分分别为4.2±0.7、4.6±0.8,差异无统计学意义(P0.05)。术后第3、7天脑室镜GCS评分明显升高,和常规开颅组相比,差异有统计学意义(P0.05);术后第1、3、7天,脑室镜组的血糖水平明显比常规开颅组下降的速度快,差异具有统计学意义(P0.05);脑室镜组头皮切口长度、骨窗大小明显比常规开颅组要小,血肿清除率大,二者差异有统计学意义;两组预后差异有统计学意义(P0.05)。结论:脑室镜治疗硬膜下血肿,具有手术时间短,创伤小,术后患者恢复速度快等优点,值得推广。

A Clinical Comparative Study between Conventional Craniotomy Operation and Ventriculoscope Treatment for Epidural Hematoma

Objective:To analyze clinical effect of operation between the routine craniotomy surgery and ventriculoscope for treatment of subdural hematoma.Methods:From January 2012 to October 201 3, a total of 63 cases with epidural hematoma were admitted in our department. 28 cases in the ventriculoscope group, including 16 males and 1 2 females, at age of 33.2 ± 9.4 years old, got ventriculoscope minimally invasive technology to clear intracranial hematoma. The other 35 cases in conventional craniotomy group, including 23 males and 1 2 females, at age of 30.2 ± 9.4 years old, received the traditional large bone flap craniotomy.Results:The preoperative GCS scores were 4.2 ± 0.7 in the conventional craniotomy group, and 4.6 ± 0.8 in the ventriculoscope comparatively, having no significant difference (P>0.05). At the 3rd and 7th day after surgery, ventriculoscope GCS score was significantly increased; and compared with conventional craniotomy group, the difference was statistically significant (P<0.05). At the 1 st, 3rd, and 7th day after surgery, the blood sugar level of ventriculoscope group decreased significantly faster than that of conventional craniotomy group, and the difference was statistically significant (P<0.05). The incision was longer and bone window size was larger in ventriculoscope group than in the conventional craniotomy group, and there was significant difference between the two groups. The clearance rate of hematoma was also higher in ventriculoscope group. The prognosis showed statistical difference between the two groups (P<0.05).Conclusion:Compared to the traditional craniotomy operation, ventriculoscope for subdural hematoma can shorten operation time, lessen trauma after the surgery, and improve the GCS score and prognosis of patients