应用DTI及ADL评估经额神经内镜下脑内血肿清除术与经颞叶皮层入路显微镜下血肿清除术对病人预后的影响

doi:10.3969/j.issn.1005-6483.20240737

临床外科杂志 ›› 2025, Vol. 33 ›› Issue (6): 585-588.doi: 10.3969/j.issn.1005-6483.20240737

应用DTI及ADL评估经额神经内镜下脑内血肿清除术与经颞叶皮层入路显微镜下血肿清除术对病人预后的影响

郭桐萁李付勇张佩斯王志超沈旭辉

110000 辽宁沈阳，中国医科大学人民医院神经外科

收稿日期:2024-05-16 出版日期:2025-06-20 发布日期:2025-06-20
通讯作者: 沈旭辉，Email:box3888@sina.com
基金资助:
2023年辽宁省博士科研启动项目（2023-BSBA-178）

DTI and ADL were used to evaluate the effect of intracerebral hematoma removal through frontal keyhole approach by neuroendoscopy and through temporal cortex by microscope on the prognosis of patients

GUO Tongqi,LI Fuyong,ZHANG Peisi,WANG Zhichao,SHEN Xuhui

Department of Neurosurgery,the People’s Hospital of China Medical University,Liaoning Province,Shenyang 110000,China

Received:2024-05-16 Online:2025-06-20 Published:2025-06-20

摘要/Abstract

摘要： 目的探讨经额锁孔入路神经内镜下基底节脑出血血肿清除术对神经传导束及预后效果的影响。方法 2017年10月~2023年10月高血压基底节区脑出血手术病人56例，根据术式不同分为两组，对照组28例，行经颞叶皮层显微镜下血肿清除术，观察组28例，行经额锁孔入路神经内镜下血肿清除术。对比两组病人术后皮质脊髓束各向异性分数（FA）及日常生活能力评分（ADL）。结果观察组FA Ⅰ级占比在格拉斯哥昏迷评分（GCS）Ⅰ级和GCSⅡ级病人中分别为88.9%和70.0%，对照组FA Ⅰ级占比在GCSⅠ级和GCSⅡ级病人中分别为75.0%和41.7%;观察组ADL Ⅰ、Ⅱ级占比在GCSⅠ级和GCSⅡ级病人中分别为94.4%和70.0%，对照组ADL Ⅰ、Ⅱ级占比在GCSⅠ级和GCSⅡ级病人中分别为81.3%和41.7%。观察组术后皮质脊髓束完整性及日常生活能力均好于对照组，两组比较差异有统计学意义(P<0.05)。结论经额锁孔入路神经内镜下血肿清除术治疗高血压基底节区脑出血对传导束影响较小，预后效果优于传统经颞叶皮层入路显微镜下血肿清除术。

关键词: 基底节脑出血；神经内镜；磁共振弥散张量成像；日常生活能力评分

Abstract: Objective To investigate the effect of through frontal keyhole approach neuroendoscopic surgery of basal ganglia hemorrhage on nerve conduction tract and prognosis.Methods 56 patients with hypertensive basal ganglia hemorrhage treated in our department from October 2017 to October 2023 were selected and divided into observation group and control group.Among them,28 patients in the control group underwent microscopic surgery through temporal cortex approach,while 28 patients in the observation group underwent endoscopic surgery through frontal keyhole approach.Fractional anisotropy and activities of daily living were compared between the two groups after operation.Results The proportion of FA Ⅰ grade in observation group was 88.9% and 70.0% in GCSⅠ grade and GCSⅡ grade patients,respectively,while in control group it was 75.0% and 41.7%.The proportion of ADL Ⅰ and Ⅱ grade in observation group was 94.4% and 70.0% in GCSⅠ grade and GCSⅡ grade patients,respectively,whereas in control group it was 81.3% and 41.7%.The integrity of the corticospinal tract and activities of daily living in observation group were better than those in control group,with statistical significance(P<0.05).Conclusion The surgery of hypertensive basal ganglia hemorrhage with neuroendoscopy through frontal keyhole approach has little influence on nerve conduction tract and the prognosis was better than traditional microscopic surgery through temporal cortex approach.

Key words: basal ganglia hemorrhage;neuroendoscopy;diffusion tensor imaging;activities of daily living

郭桐萁李付勇张佩斯王志超沈旭辉. 应用DTI及ADL评估经额神经内镜下脑内血肿清除术与经颞叶皮层入路显微镜下血肿清除术对病人预后的影响[J]. 临床外科杂志, 2025, 33(6): 585-588.

GUO Tongqi,LI Fuyong,ZHANG Peisi,WANG Zhichao,SHEN Xuhui. DTI and ADL were used to evaluate the effect of intracerebral hematoma removal through frontal keyhole approach by neuroendoscopy and through temporal cortex by microscope on the prognosis of patients[J]. JOURNAL OF CLINICAL SURGERY, 2025, 33(6): 585-588.

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应用DTI及ADL评估经额神经内镜下脑内血肿清除术与经颞叶皮层入路显微镜下血肿清除术对病人预后的影响

DTI and ADL were used to evaluate the effect of intracerebral hematoma removal through frontal keyhole approach by neuroendoscopy and through temporal cortex by microscope on the prognosis of patients

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