中国微侵袭神经外科杂志

目的 探讨接触式神经内镜下血肿清除在高血压性脑出血（hypertensive intracerebral hemorrhage,HICH）的临床疗效。方法 回顾性分析100例HICH手术患者资料，按照手术方式不同分成传统手术组（开颅血肿清除术治疗，n=50）与神经内镜组（接触式神经内镜控制下血肿清除术治疗，n=50）。比较两组患者的围手术期指标、生化指标、神经功能、日常生活活动能力、预后与术后并发症。结果 神经内镜组手术时间、住院时间，术中出血量均少于传统手术组，血肿清除率高于传统手术组，差异具有统计学意义（均P<0.05）。术前两组患者肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、C反应蛋白（C-reactive protein,CRP）及神经元特异性烯醇化酶（neuron-specific enolase,NSE）水平差异无统计学意义（均P>0.05）；治疗后两组患者TNF-ɑ、CRP水平上升，NSE水平下降，且传统手术组TNF-α、CRP、NSE水平均高于神经内镜组（均P<0.05）。术前两组患者美国国立卫生研究院卒中量表（national institutes of health stroke scale,NIHSS）、Barthel指数（Barthel index,BI）评分差异无统计学意义（均P>0.05），治疗后两组患者NIHSS评分下降，BI评分提高，且神经内镜组NIHSS评分低于传统手术组，而BI、GOS评分高于传统手术组，差异具有统计学意义（均P<0.05）。神经内镜组术后并发症发生率（2.00%）低于传统手术组（16.00%），组间比较差异具有统计学意义（P<0.05）。结论 接触式神经内镜下血肿清除治疗HICH，具有损伤小、预后好、并发症少的优势，治疗安全有效，体现微创精准治疗对患者创伤控制与功能恢复的双重优势。

Objective To investigate the clinical efficacy of contact neuroendoscopic hematoma evacuation in hypertensive intracerebral hemorrhage(HICH). Methods The clinical data of 100 surgical patients with HICH were analyzed retrospectively, who were divided into a traditional surgery group(n=50, treated with craniotomy for hematoma evacuation)and a neuroendoscopic group(n=50, treated with contact neuroendoscopic-controlled hematoma evacuation). Perioperative indicators, biochemical markers, neurological function, activities of daily living, prognosis, and postoperative complications were compared between the two groups. Results The neuroendoscopic group had shorter operation time, shorter hospital stay, and less intraoperative blood loss compared to the traditional surgery group, with a higher hematoma evacuation rate. The differences were statistically significant(all P<0.05). Before surgery, there were no significant differences in tumor necrosis factor-α(TNF-α), C-reactive protein(CRP), and neuron-specific enolase(NSE) levels between the two groups(all P>0.05).After treatment, TNF-α and CRP levels increased, while NSE levels decreased in both groups, with the traditional surgery group showing higher levels of TNF-α, CRP, and NSE than the neuroendoscopic group(all P<0.05). Before surgery, there were no significant differences in National Institutes of Health Stroke Scale(NIHSS) and Barthel Index(BI) scores between the two groups(all P>0.05). After treatment, NIHSS scores decreased, and BI scores increased in both groups, with the neuroendoscopic group having lower NIHSS scores and higher BI and Glasgow Outcome Scale(GOS) scores than the traditional surgery group. The differences were statistically significant(all P<0.05). The incidence of postoperative complications in the neuroendoscopic group(2.00%) was lower than that in the traditional surgery group(16.00%), with a statistically significant difference between the groups(P<0.05). Conclusions The treatment of HICH via contact neuroendoscopic hematoma evacuation demonstrates advantages including minimal invasiveness, favorable prognosis, and fewer complications. This approach is safe and effective, embodying the dual advantages of minimally invasive and precise therapy in terms of trauma control and functional recovery for patients.