神经内镜术和硬通道引流术治疗分隔型慢性硬膜下血肿的疗效比较

Comparisons of efficacy between neuroendoscopic hematoma evacuation and hard-channel drainage on septated chronic subdural hematoma

关键词:  神经内镜  慢性硬膜下血肿  硬通道  分隔

Key words:  neuroendoscopy  chronic subdural hematoma  hard-channel  septated

摘要:

目的 比较神经内镜血肿清除术和硬通道引流术治疗分隔型慢性硬膜下血肿（sCSDH）的手术疗效。方法 回顾性分析2013年1月至2019年1月手术治疗的53例sCSDH患者临床资料，将患者分为两组，硬通道引流组30例，神经内镜组23例。记录两组患者手术相关指标，术后随访1年，统计血肿吸收及复发情况，并发症发生率，术前、术后神经功能评分。结果 两组患者在血肿清除率，术后7天颅内积气、术后7天中线结构偏移恢复方面，差异无统计学意义（P>0.05）。神经内镜组在住院时间、手术时间方面明显多于硬通道引流组（P<0.05）；在术后3天新发少量出血、术后7天分隔残留差异方面明显少于硬通道引流组（P<0.05）。随访1年，两组患者血肿全部吸收，部分吸收，术后颅内感染，血肿复发率，术后新发出血再手术，术前、术后神经功能评分方面比较，差异无统计学意义（P>0.05），神经内镜组分隔残留明显少于硬通道引流组（P<0.05）。结论 硬通道引流在缩短手术时间，减少住院时间优势明显，但分隔残留和复发率高；神经内镜术在减少术后少量出血，减少分隔残留，降低复发率方面优势明显，安全性高。

Abstract:

Objective To investigate the effect of neuroendoscopic hematoma evacuation and hard-channel drainage on septated chronic subdural hematoma(sCSDH). Methods Fifty-three sCSDH patients from January 2013 to January 2019, were selected, including 30 patients were treated with hard-channel drainage 23 patients were treated with neuroendoscopic hematoma evacuation. The curative effect, the surgical related indicators and incidence of blood absorption and postoperative complications between treatments were compared. The preoperative and postoperative neurological function (Markwalder) were evaluated. All the patients were followed up for 1 year. Results There was no significant difference in hematoma clearance rate, intracranial pneumatosis and midline shift on the 7th day after operation between treatments. There were also no significant difference in the hematoma absorption, partial absorption, and intracranial infection after operation, hematoma recurrence rate,new bleeding reoperation, the preoperative and postoperative neurological function after 1-year follow-up. However, for the neuroendoscopy treatment, the operation time and hospitalization was significantly longer, while new micro-bleedings on the 3rd day after operation and septate residue on 7th day after operation was significantly less. Conclusion Neuroendoscopic hematoma evacuation is superior in reducing new micro-bleedings after operation and septate residue, though with a longer time in operation.