脑室镜治疗老年慢性硬膜下血肿的临床研究

Clinical research on intraventricular endoscopy in the treatment of chronic subdural hematoma in elderly patients

目的评价脑室镜治疗老年慢性硬膜下血肿的疗效。方法 2008-01～2010-06收治的121例老年慢性硬膜下血肿患者按随机对照试验设计,对照组58例行传统颅骨钻孔置管冲洗引流术,研究组63例采用颅骨钻孔脑室镜辅助下冲洗引流术,随访6-48个月,平均(26.0±18.0)个月。综合评价指标包括手术时间、平均住院日、并发症情况等。结果 121例中全部经头颅CT证实为慢性硬膜下血肿,血肿量60-120 ml。研究组平均手术时间为(22.48±3.30)min,平均住院(8.84±1.78)d,术后并发症发生率为17.5%;对照组平均手术时间为(36.05±5.41)min,平均住院(14.74±2.37)d,术后并发症发生率为63.8%。两组间平均手术时间、平均住院天数和术后并发症发生率均有明显差异(P<0.05)。结论钻孔脑室镜辅助下冲洗引流术是治疗老年慢性硬膜下血肿的有效方法,可以有效减少其复发率及手术并发症。

Objective To evaluate the effect of intraventricular endoscopy in the treatment of elderly patients with chronic subdural hematoma.Methods From January 2008 to May 2010,121 elderly patients with chronic subdural hematoma were randomized into experiment group（n=63）and control group（n=58）.The patients in control group underwent the traditional cranial drilling and catheter drainage,while the patients in experiment group underwent the cranial drilling and catheter drainage assisted with intraventricular endoscopy.All patients were followed up for 6-48 months,averaged（26.0士18.0）months,whereas the surgery time,the mean hospital stay and the complications were recorded.Results All cases were diagnosed correctly by the skull CT,with the hematoma volume of 60-120 ml.The average operation time was（22.48±3.30）min in experiment group and（36.05±5.41）min in control group（P0.05）.The average of hospital stay was（8.84±1.78）d in experiment group and（14.74±2.37）d in control group（P0.05）.The incidence of postoperative complications was 17.5% in experiment group and 63.8% in control group（P0.05）.Conclusion Cranial drilling and catheter drainage assisted with intraventricular endoscopy is an effective method in the treatment of the chronic subdural hematoma in the elderly patients,and can effectively reduce the relapse rate and complications.