RESUMO
Objective?To compare the clinical efficacy and prognosis of neural endoscopic intracranial hematoma evacuation (NEIHE) and soft channel puncture drainage (SCPD) in treatment of hypertensive intracerebral hemorrhage (HICH).?Methods?106 HICH cases from January 2015 to December 2016 were divided into endoscopic group (51 cases, NEIHE scheme) and drainage group (55 cases, SCPD scheme) according to random number, operation and complications indicators were recorded, variations on peripheral inflammatory factors and NIHSS neurological deficit score were compared, meanwhile, clinical efficacies were determined.?Results?Though the endoscopic group with operative time (108.5 ± 33.8 vs 85.8 ± 25.4) min and intraoperative blood loss (54.2 ± 17.7 vs 42.6 ± 14.5) ml were significantly higher than drainage group (P < 0.05), the endoscopic group associated with a higher hematoma clearance 48 h post operation (85.8 ± 7.8 vs 74.7 ± 9.2) % (P < 0.05) and lower overall complication rate (13.7% vs 29.1%) (P < 0.05). After 14 d, the endoscopic group with the decreased value of peripheral blood TNF-α (129.5 ± 33.7 vs 107.8 ± 29.5) pg/ml, IL-6 (74.3 ± 22.8 vs 56.7 ± 18.2) pg/ml, hs-CRP (32.6 ± 7.5 vs 27.2 ± 6.6) mg/L were all significantly higher than the drainage group (P < 0.05). After 14 d, endoscopic group with decreased value of NIHSS score was significantly higher than the drainage group (13.0 ± 3.8 vs 10.3 ± 3.5) (P < 0.05). 6 months after operation, the increased Barthel index in the survivors of endoscopic group was significantly higher than the drainage group (44.8 ± 9.7 vs 39.5 ± 11.2) (P < 0.05).?Conclusion?Though the NEIHE is more complicated than SCPD in treatment of HICH, the hematoma clearance is more complete, the complications are less, and the short-term efficacy and prognosis with obvious advantages.
RESUMO
Objective To evaluate the surgical technique and experience of endoscopic endonasal transsphenoidal approach combined with drill in surgical treatment of pituitary adenomas.Methods We retrospectively analyzed the clinical data of 29 patients suffered from pituitary adenomas,collected from September 2007 to August 2011 in our hospital,and the surgical technique and experience of endoscopic endonasal transsphenoidal approach in treating them. Results Total resection was achieved in 19 patients (65.5％),subtotal resection in 8 (27.6％) and partial resection in 2 (6.9％).Cerebrospinal leak appeared in 4 patients and temporary diatetes insipidus in 27 patients, and all these complications were controlled after treatment. Follow-up was performed for 3-8 months; the acuity of vision was improved in 15 patients (83.33％); the defect of visual field was improved in 8 (80％); headache was disappeared or relieved in 9 (81.82％).The high preoperative prolactin (PRL) level in 15 patients was obviously decreased from ([304.55+181.30] μg/L) to ([43.27+28.75] μg/L) 3 months after the surgery (P＜0.05); the high preoperative growth hormone (GH) level in 6 patients was obviously decreased from ([48.16+22.36] ng/L) to ([14.03+4.57] ng/L) 3 months afterthesurgery (P＜0.05).Conclusion Neuroendoscopic surgery combined with drill via endonasal transsphenoidal approach in the treatment of pituitary adenomas is a safe,minimally invasive and efficient procedure.