| Objective: The retrospective comparative analysis of the average operation time of neuroendoscopic surgery and ventricular puncture drainage in patients with intraventricular cast hematoma,average blood loss during surgery,average hospital stay,hematoma clearance within 24 hours,drainage tube indwelling time,surgery Hydrocephalus,mortality within 30 days after surgery,GCS score at 1 month after surgery,and KPS prognosis grade at 6 months after surgery,to investigate the influence of two different surgical methods on various indexes during the treatment of intraventricular cast hematoma,to make an evaluation of clinical effects of different minimally invasive surgical methods in treating ventricular cast hematomas,and to summarize the technical characteristics and advantages of neuroendoscopic surgery.Methods: All 100 patients were identified as ventricular cast hematomas by transcranial CT before operation.They were divided into neuroendoscopic surgery group(58 cases)and lateral ventricle puncture drainage group(42 cases)according to the surgical method.Cranial CT has been confirmed as intraventricular cast hematoma before operation,and the head and neck CTA or DSA examination was performed to exclude local cerebral blood vessels and structural abnormalities,such as cerebral vascular malformations or intracranial aneurysm rupture and bleeding.Among them,there were 40 males and 18 females in the neuroendoscopic surgery group,aged between 41-82 years,with an average age(55.90 ± 8.88)years.The GCS score at admission was 4-15,with an average of(7.83± 2.72)minutes,intraventricular cast hematoma volume being(34.07 ± 7.31)ml.There were 29 males and 13 females in the lateral ventricular puncture external drainage group,aged between 34-85 years,with an average age of(55.21 ± 10.16)years.The GCS score at admission was 3-15,with an average of(7.88 ± 3.20)minutes,intraventricular cast hematoma volume(32.71 ± 7.54)ml.(1)Compare the surgical time,intraoperative blood loss,drainage tube indwelling time,and average hospitalization time of the patients in the neuroendoscopic surgery group and the lateral ventricular puncture drainage group,and explore two different surgical methods in the treatment of intraventricular casting The impact of hematoma on various indicators.(2)Compare the 24 h postoperative hematoma clearance rate,postoperative hydrocephalus,and postoperative mortality within 30 days of patients in the neuroendoscopic surgery group and the lateral ventricular puncture drainage group,and evaluate the neuroendoscopic surgery for the treatment of ventricular cast hematomas in Clinical effect.(3)The GCS scores of 1 month after surgery and KPS scores of 6 months after surgery were compared between patients in the neuroendoscopic surgery group and the lateral ventricular puncture drainage group to evaluate the degree of dependence of patients on daily life.(4)After statistical analysis of the above experimental data,summarize the technical characteristics and advantages of neuroendoscopic surgery.Results:(1)The average operation time of patients in the neuroendoscopic surgery group was(81.67 ± 7.66)min,the average blood loss during the operation was(59.83 ± 11.03)ml,the indwelling time of the ventricle drainage tube was(5.29 ± 2.59)days,and the average hospital stay was(18.31 ± 8.50)days.The average operation time of patients in the lateral ventricle puncture and external drainage group was(31.07 ± 10.10)min.The average blood loss during the operation was(15.67 ± 5.12)ml,and the indwelling time of the ventricle drainage tube was(7.00 ± 3.74)d.The average blood loss during surgery,the average operation time,the indwelling time of the ventricle drainage tube,and the average length of hospital stay were statistically significant(P <0.05).(2)Hematoma clearance within 24 hours in the neuroendoscopic surgery group was> 80% in 36 cases(62.1%),40-80% in 17 cases(29.3%),<40% in 5 cases(8.6%),and the effective rate was 53 cases(81.4%).In the lateral ventricular puncture drainage group,the hematoma clearance rate within 24 hours was> 80% in 0 cases,40-80% in 9 cases(21.4%),<40% in 33 cases(78.6%),and the effective rate in 9 cases(21.4%);Hematoma clearance data within 24 hours after surgery between the two groups were statistically different by rank sum test(P <0.05).(3)Eight patients(13.8%)needed shunt hydrocephalus after surgery in the neuroendoscopic surgery group,and 6(10.3%)died within 30 days after surgery.Patients with shunt hydrocephalus needed after surgery in the lateral ventricle puncture and drainage group 7 Cases(16.7%),and 11 cases(26.2%)died within 30 days after operation.(4)The average GCS score of patients in the neuroendoscopic surgery group at 1 month(11.47 ± 3.66)points and the average KPS score of 6 months after surgery(65.86 ± 28.78)points;the patients in the lateral ventricle puncture and drainage group had an average of 1 month after surgery.The GCS score was(9.64 ± 4.95)ml,and the average KPS score at June was(50.00 ± 36.76).There was a statistically significant difference in the average GCS score and postoperative KPS score data between the two groups of patients(P <0.05).Conclusion:(1).For the treatment of ventricular cast hematomas,compared with lateral ventricular puncture and drainage,neuroendoscopic surgery has a longer average time,more bleeding during the operation.However,the average length of stay and the indwelling time of ventricular drainage tube were short.(2).Patients in the neuroendoscopic surgery group had higher hematoma clearance within 24 hours after surgery.The incidence of shunt hydrocephalus after surgery and mortality within 30 days after surgery were lower.(3).By comparing and analyzing the GCS scores and KPS scores of the follow-up patients at 1 month and 6 months after operation,the patients' quality of life was higher.In summary,neuroendoscopic surgery can improve the prognosis,improve the quality of life of patients after surgery,reduce the economic burden on families and society,and effectively reduce the mortality and disability rate.It is a new technology ? worth promoting and applying. |
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