3种微创技术治疗慢性硬膜下血肿的疗效分析

Therapeutic effect of three minimally invasive surgical procedures for chronic subdural hematoma

目的比较单骨孔、双骨孔及小骨窗技术外科治疗慢性硬膜下血肿(chronic subdural hematoma,CSDH)的手术疗效。方法回顾性分析2005年10月至2010年12月手术治疗的125例CSDH患者的临床资料,将患者分为3组:单骨孔组31例,骨孔直径1 cm;双骨孔组50例,骨孔直径1 cm,分别于血肿前后各钻骨孔1个;小骨窗组44例,术中将骨孔扩大成直径2～3 cm的骨窗。结果 3组患者术后7 d的残存血肿量及出院时的神经功能状态无明显差异(P>0.05)。单骨孔组的手术时间较双骨孔组及小骨窗组明显缩短(P<0.05)。单骨孔及双骨孔组在住院天数、并发症方面无明显差异(P>0.05),但均较小骨窗组明显增高(P<0.05)。单骨孔组的复发率较双骨孔组及小骨窗组明显增高(P<0.05),后2组间无明显差异(P>0.05)。多变量回归分析显示手术方式是影响术后复发的独立因素,相对于单骨孔技术,双骨孔技术复发率的降低具有统计学意义(OR=0.148,95%CI 0.026～0.847,P=0.032)。结论小骨窗技术可作为治疗CSDH首选的治疗方法,双骨孔技术可有效降低术后复发率,尤其适用于术后复发患者。

Objective To compare craniotomy, and small craniotomy for chronic CSDH patients who underwent operation in the therapeutic effect of one burr-hole craniotomy, two burr-hole subdural hematoma （CSDH）. Methods Clinical data about 125 our hospital from October 2005 to December 2010 were retro- spectively analyzed. The patients were divided into one burr-hole craniotomy group （ group A, n = 31 ） with the burr hole size of about 10 mm in diameter, two burr-hole craniotomy （group B, n = 50） with the burr hole size of about 10 mm in diameter, and small craniotomy group （ group C, n = 44） with the burr hole size of 20 - 30 mm according to their surgical procedure. Results No significant difference was found in residual hemato- mas in 7 d after operation and in neural function at discharge among the 3 groups （ P 〉 0. 05 ）. The operation time was significantly shorter in group A than in groups B and C （ P 〈 0. 05 ）. No significant difference was observed in hospital stay time （day） and incidence of inflammation between group A and group B （ P 〉 0. 05 ）. However, the hospital stay time （day） was significantly longer and the incidence of inflammation was signifi- cantly higher in groups A and B than in group C （P 〈 0.05 ）. The incidence of relapse was significantly higher in group A than in groups B and C （ P 〈 0. 05 ） with no significant difference between groups B and C （ P 〉 0. 05 ）. Multivariate regression analysis showed that the surgical procedure was an independent factor for relapse after operation while the incidence of relapse was significantly lower after one burr-hole craniotomy than after two burr-hole eraniotomy （OR=0. 148,95%CI=0.026 -0.847, P =0.032）. Conclusion Small craniotomy is the first choice of surgical procedure for CSDH while two burr-hole craniotomy can reduce the incidence of relapse, especially in patients after operation.