锁孔入路内镜辅助额部硬膜外血肿清除术的临床研究

Endoscope-assisted keyhole approach in frontal epidural hematoma clearance: a clinical study

目的探讨神经内镜辅助下经锁孔入路治疗外伤性额部硬膜外血肿的方法及效果。方法对60例外伤性额部硬膜外血肿(急性硬膜外血肿16例,亚急性硬膜外血肿44例)行额部或眶上锁孔入路,在神经内镜直视下清除血肿,分析患者的临床资料和手术疗效。结果 60例患者平均手术时间(1.1±0.3)h,血肿清除率(89.5±5.2)﹪,平均住院时间6.8天,术后半年患者日常生活能力(activities of daily living,ADL)分级,达到I级45例,Ⅱ级10例,Ⅲ级4例,Ⅳ级l例,V级0例。结论神经内镜辅助下经额部或眶上锁孔入路额部硬膜外血肿清除术具有创伤小、手术时间短、血肿清除率高、住院时间短、术后恢复好等优点。但需严格选择病例及把握手术适应症。

Objective To investigate the method and effect of neuroendoscope-assisted keyhole approach in the traumatic frontal epidural hematoma clearance. Methods A total of 60 patients with traumatic frontal epidural hematoma were enrolled（ 16 with acute epidural hematoma and 44 with subacute epidural hematoma） and underwent frontal or supraorbital keyhole approach,and hematoma was removed under the direct view of a neuroendoscope. The patients＇ clinical data and surgical outcome were analyzed. Results In all 60 patients,the mean time of operation was 1. 1 ± 0. 3 hours,the hematoma clearance rate was 89. 5% ± 5. 2%,and the mean hospital stay was 6. 8 days. At 6 months after surgery,activities of daily living（ ADL） were classified for all patients,and among these patients,45 had class I,10 had class II,4 had class III,1 had class IV,and no patient had class V. Conclusions Neuroendoscope-assisted frontal or supraorbital keyhole approach for frontal epidural hematoma clearance has the advantages of little trauma,a short time of operation,a high hematoma clearance rate,a short hospital stay,and good postoperative recovery,but it is important to strictly select cases and control surgical indications.