微创锥颅无皮下隧道脑室外引流术治疗脑室出血的疗效观察

doi:10.19854/j.cnki.1008-2425.2026.02.0006

摘要/Abstract

摘要： 目的探讨微创锥颅无皮下隧道脑室外引流术治疗脑室出血的手术方法及疗效观察。方法回顾性研究了2018年2月-2024年4月本院收治的104例脑室出血(包括原发性脑室出血和继发性脑室出血)患者,其中有49例采用微创锥颅无皮下隧道脑室外引流术(观察组)和55例接受传统切口钻孔脑室外引流术(对照组)治疗脑室出血。统计比较两组患者基线资料(年龄、性别、GCS评分、出血类型等)、麻醉方式(全麻或局麻)、手术时长、住院时间,围手术期并发症发生率(颅内感染、脑积水、穿刺道出血、细菌性肺炎)、术后3个月的预后良好率(格拉斯哥预后GOS评分)等结局变量。结果两组患者基线资料比较差异无统计学意义(P＞0.05),具有可比性;改良组多采用局麻手术方式,住院天数、手术时间均短于对照组(P＜0.05),颅内感染、细菌性肺炎发生率低于对照组(P＜0.05);术后3月GOS评分优于对照组(P＜0.05);穿刺道出血、交通性脑积水发生率两组比较并无统计学差异(P＞0.05)。结论微创锥颅无皮下隧道脑室外引流术大多采用局麻,手术时间短,可有效提升患者手术预后,减少颅内感染、细菌性肺炎等手术并发症,加快术后恢复时间,值得临床推广。

关键词: 脑室出血, 脑室外引流术, 锥颅, 并发症

Abstract: Objective To investigate the surgical method and therapeutic effect of minimally invasive transtemporal craniostomy without subcutaneous tunnel for external ventricular drainage in the treatment of intraventricular hemorrhage. Methods A retrospective study was conducted on 104 patients with intraventricular hemorrhage (including primary and secondary intraventricular hemorrhage) admitted to our hospital from February 2018 to April 2024.Among them,49 patients underwent minimally invasive transtemporal craniostomy without subcutaneous tunnel for external ventricular drainage (observation group),and 55 patients received traditional incision and drilling for external ventricular drainage (control group).The baseline data (age,gender,Glasgow Coma Scale[GCS] score,type of hemorrhage,etc.),anesthesia method (general anesthesia or local anesthesia),operation duration,length of hospital stay,incidence of perioperative complications (intracranial infection,hydrocephalus,puncture tract hemorrhage,bacterial pneumonia),and good prognosis rate at 3 months after surgery (Glasgow Outcome Scale[GOS]score) were statistically compared between the two groups. Results There was no statistically significant difference in baseline data between the two groups (P＞0.05),indicating good comparability.Most patients in the observation group received local anesthesia;the length of hospital stay and operation duration in the observation group were shorter than those in the control group (P＜0.05),and the incidences of intracranial infection and bacterial pneumonia were lower (P＜0.05).The GOS score at 3 months after surgery in the observation group was better than that in the control group (P＜0.05).There were no statistically significant differences in the incidences of puncture tract hemorrhage and communicating hydrocephalus between the two groups (P＞0.05). Conclusion Minimally invasive transtemporal craniostomy without subcutaneous tunnel for external ventricular drainage is mostly performed under local anesthesia with a short operation duration.It can effectively improve the surgical prognosis of patients,reduce the incidence of surgical complications such as intracranial infection and bacterial pneumonia,and accelerate postoperative recovery.This surgical method is worthy of clinical promotion.

Key words: Intraventricular hemorrhage, EVD, Stereotaxic aspiration, Complication

中图分类号:

R743.34

张旭, 严志忠, 吴文凯, 时忠华, 陈军辉, 王玉海. 微创锥颅无皮下隧道脑室外引流术治疗脑室出血的疗效观察[J]. 立体定向和功能性神经外科杂志, 2026, 39(2): 100-105.

Zhang Xu, Yan Zhizhong, Wu Weikai, Shi Zhonghua, Chen Junhui, Wang Yuhai. Observation of the therapeutic effect of minimally invasive craniotomy without subcutaneous tunnel for intraventricular drainage in the treatment of intraventricular hemorrhage[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2026, 39(2): 100-105.

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