神经内镜与显微镜治疗ChiariⅠ型疗效对比研究

发布时间：2018-11-01 17:01

【摘要】：目的:通过观察比较对小脑扁桃体下疝I型(CM-I)患者分别采用神经内镜与显微镜下行单纯寰枕减压术的疗效,探讨二种术式各自的优势和不足,为临床CM-I型最佳手术方式的选择提供依据。方法:收集整理山西省人民医院神经外科从2007年1月到2016年1月共96例首诊CM-I患者的临床资料,根据手术方式选择的不同分为神经内镜下寰枕减压术组和显微镜下寰枕减压术组);对比两组患者术前临床体征,术中手术相关数据和术后恢复情况,并对相关资料进行分析比较。计量资料使用t检验处理,c2检验用来检验计数资料,P0.05为有统计学意义。结果:本组手术病例无死亡和严重并发症。其中内镜手术组42例,症状改善40例(95.2%),症状不变2例(4.8%)。显微手术组54例,症状改善48例(88.9%),症状不变6例(11.1%)。出院后随访:通过电话、短信、门诊复查、邮件等手段回访,回访时间半年-5年。SPSS17.0软件处理数据,内镜手术的患者在手术时间、术中失血量、住院费用等指标均优于显微手术组,采用卡方检验可得P值0.05,有统计学意义。按照CCOS评价内镜组显微镜组手术效果和并发症对比,采用卡方检验可得P值0.05,两者差异无显著性。结论:对于治疗ChiariⅠ型的寰枕减压手术,不论显微镜下操作,或内镜下手术,均能取得寰枕减压的效果。但内镜下寰枕减压手术更加微创,对寰枕部稳定性影响小,且住院时间短,住院费用低。
[Abstract]:Objective: to observe and compare the effects of simple decompression of occipital atlanto under neuroendoscopy and microscope in patients with type I (CM-I) subtonsillar hernia of cerebellum, and to explore the respective advantages and disadvantages of the two methods. To provide the basis for the selection of the best operation mode of clinical CM-I type. Methods: the clinical data of 96 patients with CM-I in Shanxi Provincial people's Hospital from January 2007 to January 2016 were collected and analyzed. According to the choice of surgical methods were divided into endoscopic atlantooccipital decompression group and microscopically atlantooccipital decompression group); The preoperative clinical signs, intraoperative data and postoperative recovery were compared between the two groups. The measurement data were processed by t test, and the count data were checked by c 2 test, P 0.05 was statistically significant. Results: there were no death and serious complications in this group. There were 42 cases in endoscopic surgery group, 40 cases (95.2%) were improved and 2 cases (4.8%) were unchanged. In the microsurgery group, the symptoms were improved in 48 cases (88. 9%) and unchanged in 6 cases (11. 1%). Follow up after discharge: by telephone, short message, outpatient review, mail and other means, the return visit time is 6 months to 5 years. SPSS17.0 software processing data, endoscopic surgery patients in the operation time, intraoperative blood loss, The cost of hospitalization was better than that of microsurgery group, P value was 0.05 by chi-square test, which had statistical significance. According to the CCOS evaluation of the endoscopic group microscope group operation results and complications, chi-square test was used to obtain P value 0.05, there was no significant difference between the two groups. Conclusion: global occipital decompression can be achieved either under microscope or under endoscope for the treatment of Chiari type I atlantooccipital decompression. But endoscopic occipital decompression is more minimally invasive and has little effect on the stability of occipital part, short hospitalization time and low hospitalization cost.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.1

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