【摘要】：目的:研究分析對(duì)比神經(jīng)導(dǎo)航輔助內(nèi)鏡與顯微鏡下開(kāi)顱手術(shù)治療高血壓腦出血療效;探討其臨床應(yīng)用及價(jià)值。方法:收集自2012年1月-2016年11月應(yīng)用神經(jīng)導(dǎo)航輔助內(nèi)鏡手術(shù)治療的患者,隨機(jī)抽取30例為導(dǎo)航內(nèi)鏡組;收集開(kāi)顱手術(shù)治療高血壓腦出血的患者,隨機(jī)抽取30例為顯微開(kāi)顱組。采用相同的納入和排除標(biāo)準(zhǔn)。記錄兩組患者術(shù)后GCS評(píng)分,皮膚切口長(zhǎng)度、手術(shù)時(shí)間、手術(shù)出血量、住院時(shí)間、術(shù)后并發(fā)癥及術(shù)后隨訪第6個(gè)月KPS評(píng)分進(jìn)行比較分析。結(jié)果:導(dǎo)航內(nèi)鏡組與顯微開(kāi)顱組相比,術(shù)后GCS昏迷評(píng)分兩組差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);在皮膚切口上,導(dǎo)航內(nèi)鏡組平均切口長(zhǎng)度為(4.22±0.43)cm,顯微開(kāi)顱組平均切口長(zhǎng)度為(13.23±1.00)cm,兩組差異有統(tǒng)計(jì)學(xué)意義(P0.05);在手術(shù)時(shí)間上,導(dǎo)航內(nèi)鏡組平均手術(shù)時(shí)間為(90.27±14.31)min,顯微開(kāi)顱組的平均手術(shù)時(shí)間為(186.50±26.62)min,兩組差異有統(tǒng)計(jì)學(xué)意義(P0.05);在手術(shù)出血量上,導(dǎo)航內(nèi)鏡組平均出血量為(74.33±22.23)ml,顯微開(kāi)顱組平均出血量為(194.33±35.40)ml,兩組對(duì)比差異有統(tǒng)計(jì)學(xué)意義(P0.05);在住院天數(shù)上,導(dǎo)航內(nèi)鏡組平均住院天數(shù)為(12.40±2.28)d,顯微開(kāi)顱組的平均住院天數(shù)為(15.87±2.42)d,兩組對(duì)比差異有統(tǒng)計(jì)學(xué)意義(P0.05);在并發(fā)癥上,導(dǎo)航內(nèi)鏡組發(fā)病率明顯低于顯微開(kāi)顱組,兩組對(duì)比差異有統(tǒng)計(jì)學(xué)意義(P0.05);術(shù)后隨訪6個(gè)月KPS評(píng)分導(dǎo)航內(nèi)鏡組預(yù)后優(yōu)于顯微開(kāi)顱組,兩組對(duì)比差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:神經(jīng)導(dǎo)航輔助內(nèi)鏡治療高血壓腦出血定位準(zhǔn)確、微創(chuàng)、直視、省時(shí)、止血充分,出血量少、縮短住院天數(shù)、降低并發(fā)癥發(fā)病率,術(shù)后生活質(zhì)量較好;其應(yīng)用前景廣闊、在臨床方面值得推廣。
[Abstract]:Objective: to study and compare the therapeutic effects of neuronavigation assisted endoscopy and microscopical craniotomy on hypertensive intracerebral hemorrhage (hypertensive intracerebral hemorrhage), and to explore its clinical application and value. Methods: from January 2012 to November 2016, 30 patients with hypertensive intracerebral hemorrhage were randomly selected as navigation endoscopy group and 30 patients were randomly selected as microcraniotomy group. Apply the same inclusion and exclusion criteria. The GCS score, incision length, operation time, blood loss, hospital stay, postoperative complications and KPS score were compared between the two groups. Results: there was no significant difference in GCS coma score between the navigation endoscopy group and the microcraniotomy group (P0.05). In the skin incision, the average incision length of the navigation endoscope group was (4.22 鹵0.43) cm, microcraniotomy group was (13.23 鹵1.00) cm, there was significant difference between the two groups (P0.05). In the operation time, the mean operation time of the navigation endoscope group was (90.27 鹵14.31) min, microcraniotomy group was (186.50 鹵26.62) min, there was significant difference between the two groups (P0.05). The mean amount of blood loss in the navigation endoscopy group was (74.33 鹵22.23) ml, microcraniotomy group was (194.33 鹵35.40) ml, there was significant difference between the two groups (P0.05). The average hospitalization days were (12.40 鹵2.28) days in the navigation endoscopy group and (15.87 鹵2.42) days in the microcraniotomy group. The difference between the two groups was statistically significant (P0.05). In the complications, the incidence of navigation endoscopic group was significantly lower than that of microcraniotomy group, the difference between the two groups was statistically significant (P0.05). The prognosis of the endoscopic group was better than that of the microcraniotomy group after 6 months follow-up with KPS score. The difference between the two groups was statistically significant (P0.05). Conclusion: neuronavigation assisted endoscopy in the treatment of hypertensive intracerebral hemorrhage is accurate, minimally invasive, direct vision, time-saving, sufficient hemostasis, less bleeding, shorter hospitalization days, lower incidence of complications and better quality of life after operation. Its application prospect is broad, in the clinical aspect is worth popularizing.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R651.1

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