目的:探讨开颅手术与神经内镜治疗幕上高血压脑出血的临床应用价值.方法:幕上高血压脑出血患者62例,随机分为两组,其中应用开颅手术清除血肿的患者为开颅组(n=34),应用神经内镜微创手术治疗的患者为内镜组(n=28).对两组患者的临床治疗效果进行比较,分析两种术式的临床应用价值.结果:开颅组术后第1天血肿清除率为90.3% ± 6.2%,内镜组为87. 4% ± 8.2 %,差异无统计学意义(P>0.05).开颅组患者的平均手术时间为(212.6 ± 69.5)min,术中出血量为(280.4 ± 103.8)ml,而内镜组的手术时间和术中出血量分别为(79.1 ± 15.7)min和(85.9 ± 14.6)ml,两者比较差异均有统计学意义(P<0.01).此外,在住院时间、平均住院花费两方面,开颅组亦明显多于内镜组,差异具有统计学意义(P<0.05).同时在再出血率、术后感染、消化道出血、癫痫等并发症方面,内镜组均优于开颅组,但差异没有统计学意义(P>0.05).而在病死率以及GOS评分方面,内镜组虽然优于开颅组,但差异亦没有统计学意义(P>0.05).结论:较之于开颅手术清除血肿,神经内镜微创手术是一种创伤小、成本低、快速、高效、并发症低、值得临床推广的手术方式,但该术式亦不能提高患者的预后.%Objective:To compare the clinical effects of craniotomy and endoscopic surgery for treating sponta-neous supratentorial intracerebral hemorrhage.Methods:62 cases of patients with spontaneous supratentorial intrac-erebral hemorrhage were randomly divided into two groups.Patients in the craniotomy group(n=34)were treated with craniotomy to remove the hematoma,while patients in the endoscopic group(n=42)were treated with endo-scopic surgery.The clinical effects of two operation were compared,and the clinical application value was analyzed. Results:1 day after operation,hematoma evacuation rate in the craniotomy group was 90.3% ± 6.2 %,and it was 87.4% ± 8.2% in the endoscopic group,the difference was not statistically significant(P>0.05).The mean opera-tion time and intraoperative blood loss in the craniotomy group were(212.6 ± 69.5)min and(280.4 ± 103.8)ml,re-spectively.While these were(79.1 ± 15.7)min and(85.9 ± 14.6)ml in the endoscopic group.For both,the differ-ences were statistically significant(P<0.01).In addition,hospitalization length and total expenditure in the craniot-omy group were much more than those in the endoscopic group(P<0.05).Furthermore,mortality,GOS scores and complications such as rebleeding rate,postoperative infection,gastrointestinal bleeding and epilepsy in the craniotomy group was superior to those in the endoscopic group,but there were no statistical difference between both groups(P>0.05).Conclusion:Compared with craniotomy,endoscopic surgery is lesser trauma,lower cost,rapid,more efficient, low complication and worthy of clinical popularization,but the operation can not improve the prognosis of patients.
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