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目的应用神经内镜采取经皮质加透明隔造瘘的方法治疗脑室出血,同时与常规脑室外引流治疗脑室出血做对比,观察两种方法的临床疗效。方法将浙江大学金华医院2012年6月—2014年6月,符合自发性脑室出血诊断标准的112例患者随机分为治疗组和对照组,治疗组57例采用内镜下经皮质加透明隔造瘘术治疗,对照组55例采用脑室外引流术治疗。主要观察2组患者的手术时间、术后3 d CT血肿清除情况、置管时间、术后并发症(继发性出血、颅内感染、脑积水)、病程及3个月后格拉斯哥预后评分(GOS)等临床疗效性指标。采用SPSS13.0统计软件对上述疗效指标进行统计分析。组间对比运用t检验,计数资料采用χ~2检验,等级资料采用秩和检验。通过统计分析比较2组患者的预后。结果术后3 d CT显示,治疗组50例(87.72%)患者血肿清除率≥50%,对照组18例(32.73%)患者血肿清除率≥50%,2组差异有统计学意义(Z=6.2002,P<0.01)。同时治疗组在术后并发症、置管时间、病程、病死率、术后3个月格拉斯哥预后评分等方面均优于对照组(统计值分别为χ~2=4.193,χ~2=11.009,χ~2=9.843,t=14.096,t=14.629,Z=3.239,P<0.05)。而2组间手术时间差异无统计学意义(P>0.05)。结论神经内镜下经皮质加透明隔造瘘清除脑室出血,血肿清除率高,可明显降低自发性脑室出血患者的致残率和病死率,减少并发症,缩短病程,减轻患者家庭经济负担。
Objective To observe the clinical curative effect of two methods by using neuroendocrine to treat cerebral venous hemorrhage by transcortical and translucent fistula. Methods From June 2012 to June 2014, Jinhua Hospital of Zhejiang University from January 2012 to June 2014, 112 patients who were diagnosed as spontaneous intraventricular hemorrhage were randomly divided into treatment group and control group. 57 cases in treatment group were treated with endoscopic transcortical and translucent Fistula treatment, 55 cases of control group were treated with ventricular drainage. The operative time, CT hematoma clearance, catheterization time, postoperative complications (secondary hemorrhage, intracranial infection, hydrocephalus), duration of disease and the Glasgow prognostic score at 3 months postoperatively (GOS) and other clinical efficacy indicators. Using SPSS13.0 statistical software for statistical analysis of the above efficacy indicators. T-test was used to compare between groups. Chi-square test was used to count the data, rank-sum test to grade data. The prognosis of the two groups was compared by statistical analysis. Results Three days after operation, hematoma clearance rate was 50% in 50 cases (87.72%) in treatment group and hematoma clearance rate (≥50%) in 18 cases (32.73%) in control group, with significant difference between the two groups (Z = 6.2002, P <0.01). At the same time, the treatment group was superior to the control group in postoperative complications, catheterization time, course of disease, mortality, and Glasgow prognostic score at 3 months after operation (statistics values were χ ~ 2 = 4.193, χ ~ 2 = 11.009, χ ~ 2 = 9.843, t = 14.096, t = 14.629, Z = 3.239, P <0.05). There was no significant difference in operative time between the two groups (P> 0.05). Conclusions Endoscopic transcortical and translumenal fistula clearance of ventricular hemorrhage, high hematoma clearance rate can significantly reduce the morbidity and mortality of patients with spontaneous ventricular hemorrhage, reduce complications, shorten the course of disease and reduce the financial burden on the family.