应用软性神经内镜技术治疗慢性硬膜下血肿的疗效分析

Efficacy analysis of soft neuroendoscopic techniques in the treatment of chronic subdural hematoma

目的探讨应用软性神经内镜技术治疗慢性硬膜下血肿(CSDH)的疗效。方法回顾分析首都医科大学附属北京世纪坛医院神经外科2006年1月至2017年12月诊治的201例CSDH2006年1月至2010年12月颅骨钻孔引流术治疗CSDH126例(非内镜组),2011年1月至2017年12月软性神经内镜治疗CSDH75例(内镜组)。比较两组患者死亡率、手术时间、血肿清除率(术后第1天)、引流管留置时间、住院时间、并发症及复发率。结果两组均未出现死亡病例。平均手术时间非内镜组43min,内镜组50min,P>0.05;术后第1天平均血肿清除率,内镜组(98.2%)明显高于非内镜组(87.3%)(P<0.01);内镜组平均引流管留置时间23h明显短于非内镜组50h(P<0.01);术后第1天内镜组mRS≤3患者比例显著高于非内镜组P<0.01,出院时内镜组mRS≤3患者比例也显著高于非内镜组,P<0.05;内镜组平均住院时间为7d,非内镜组为8d,两组比较P>0.05;内镜组术后并发症发生率明显低于非内镜组,P<0.01;随访0.5-8年,内镜组CSDH复发率(5.33%)明显低于非内镜组(15.07%),P<0.01。结论应用软性神经内镜可视化操作特点治疗CSDH能够显著提高血肿清除率,缩短引流管留置时间,降低术后并发症和CSDH复发率。

Objective To investigate the efficacy of soft neuroendoscopic techniques in the treatment of chronic subdural hematoma (CSDH).Methods A retrospective analysis of 201 cases of CSDH diagnosed and treated at Beijing Shijitan Hospital (CMU) from January 2006 to December 2017 was conducted.From January 2006 to December 2010,126 cases of CSDH were treated with skull drilling and drainage (non-endoscopic group).From January 2011 to December 2017,75 cases of CSDH were treated with soft neuroendoscopy (endoscopic group).The operation time of the non-endoscopic and endoscopic groups,the hematoma clearance rate on the first day after surgery,the time of the drainage tube,the length of hospital stay,the incidence of complications,mortality and recurrence rate were compared.Results There were no deaths in both groups.The average operation time of the non-endoscopic group was 43 min,compared with the average operation time of the endoscopy group of 50 min,there was no significant difference (P>0.05).The average hematoma clearance rate on the first day after surgery in the endoscopy group (98.2%) was significantly higher than that in non-endoscopic group (87.3%) (P<0.01).The average time of drainage tube in the endoscopy group (23 h) was significantly shorter than that in the non-endoscopic group (50 h) (P<0.01).On the first postoperative day,the proportion of patients with mRS≤3 in the endoscopic group was significantly higher than that in the non-endoscopic group (P<0.01).At the time of discharge,the proportion of patients with mRS≤3 in the endoscopy group was also significantly higher than that in the non-endoscopic group,P<0.05.There was no significant difference in the average hospital stay between endoscopy group (7 d) and non-endoscopic group (8 d) (P>0.05).The postoperative complication rate in the endoscopy group was significantly lower than that in the non-endoscopic group (P<0.01).During 0.5-8 years of follow-up,the recurrence rate of CSDH in the endoscopic group (5.33%) was significantly lower than that in the non-endoscopic group (15.07%) (P<0.01).Conclusion The application of visualization features of soft neuroendoscopy in the treatment of CSDH can significantly improve hematoma clearance,shorten the time of drainage tube,reduce postoperative complications and recurrence rate,and improve surgical outcomes.