摘要：
Objective To explore the efficacy of neuroendoscopy combined with ventricular irrigation in the treatment of severe intraventricular hemorrhage.Methods A retrospective study was conducted on 145 cases of severe intraventricular hemorrhage admitted to Department of Neurosurgery at Harrison International Peace Hospital Mfiliated to Hebei Medical University from January 2015 to November 2017.Among them,65 cases were treated by neuroendoscopy combined with ventricular irrigation (neuroendoscope group) and 80 were treated with external ventricular drainage (drilling drainage group).The hospital stay length,recovery time of cerebrospinal fluid,intracranial infection rate,hematoma clearance and rebleeding rate at 6h post operation were compared between the 2 groups.After 6 months of follow-up,the occurrence of hydrocephalus was assessed according to CT examination and the patient's outcome was assessed according to the activity of daily living (ADL) score.The Bsrsel index ≥ 90％ indicated that the patient had a good outcome.Results Compared with the drilling drainage group,the recovery time of cerebrospinal fluid after neuroendoscopy was shortened (3.9 ± 0.9 min vs.4.6 ± 1.1 min,P =0.034),the clearance rate of hematoma was significantly higher [23.1％ (15/65) vs.2.5％ (2/80),P ＜ 0.001].There was no significant difference between the two groups in hospital stay length,the incidence of intracranial infection and rebleeding rate after operation (all P ＞ 0.05).After 6 months,the rate of good outcome in the neuroendoscopy group was better than in the drilling drainage group [50.8％ (33/65) vs.28.8％ (23/80),P =0.001].The occurrence rate of hydrocephalus [4.6％ (3/65) vs.16.3％ (13/80)] and mortality rate [4.6％ (3/65) vs.15.0％ (12/80)] were lower than those in the drilling drainage group(both P ＜ 0.05).Conclusion Neuroendoscopy combined with ventricular irrigation could effectively improve clinical efficacy,reduce complications and improve the outcome of severe ventricular hemorrhage,which might be worthy of clinical promotion.%目的 探讨应用神经内镜血肿清除术联合脑室灌洗治疗重型脑室出血的疗效.方法 回顾性纳入2015年1月至2017年1 1月河北医科大学附属哈励逊国际和平医院神经外科收治145例重型脑室出血患者,其中65例采用神经内镜经皮质-脑室入路血肿清除术联合脑室灌洗治疗(神经内镜组),80例采用钻孔外引流术治疗(钻孔引流组).比较两组患者的住院时间、脑脊液循环通畅时间、颅内感染率、术后6h的血肿清除率及再出血发生率.术后6个月随访,复查头颅CT评估患者脑积水情况,根据日常生活能力量表(ADL)评估患者预后,以Barthel指数≥90％表示预后良好.结果 与钻孔引流组比较,神经内镜组患者术后脑脊液循环时间缩短[分别为(3.9±0.9) min、(4.6±1.1)min,P=0.034],血肿清除率增加[分别为23.1％ (15/65)、2.5％(2/80),P＜0.001].而住院时间、术后再出血率及颅内感染率,两组间的差异均无统计学意义(均P＞0.05).术后6个月,神经内镜组患者的预后良好率高于钻孔引流组[分别为50.8％(33/65)、28.8％(23/80),P=0.001],而脑积水发生率[分别为4.6％(3/65)、16.3％ (13/80)]和病死率[分别为4.6％(3/65)、15.0％ (12/80)]均低于钻孔引流组(均P＜0.05).结论 神经内镜血肿清除术联合脑室灌洗治疗重型脑室出血能有效提高疗效、降低并发症及改善预后,值得临床推广.
