神经导航及内镜在慢性硬膜下血肿治疗中应用效果分析

Application of neuronavigation and endoscopy in the treatment of chronic subdural hematoma

目的探究慢性硬膜下血肿术中采用神经导航和内镜的应用效果。方法选取深圳市人民医院神经外科自2014年6月至2018年6月收治的硬膜下血肿患者116例,根据患者术中应用设备情况分成常规手术治疗组(64例)与神经导航内镜辅助组(52例)。于术后1周复查,比较2组患者的血肿复发、血肿残留、颅内积气的情况;术后1个月复查,对比2组患者的血肿复发残留情况。结果患者术后1周进行CT复查,常规手术治疗组部分血肿残留19例、血肿消失45例,神经导航内镜辅助组部分血肿残留7例、血肿消失45例,2组比较差异有统计学意义(P=0.037)。常规手术治疗组硬膜下积液、积气6例,无积液、积气58例;神经导航内镜辅助组硬膜下积液、积气4例,无积液、积气48例;2组比较差异无统计学意义(P=0.748)。患者术后1个月进行CT复查,常规手术治疗组血肿残留或复发11例、血肿消失53例;神经导航内镜辅助组血肿残留或复发3例、血肿消失49例,差异有统计学意义(P=0.038)。结论应用神经导航及内镜辅助进行慢性硬膜下血肿钻孔引流术,可提高血肿完全清除率,并降低远期血肿复发率,具有一定的应用价值。

Objective To explore the effect of neuronavigation and endoscopy in the operation of chronic subdural hematoma. Methods One hundred and sixteen patients with subdural hematoma admitted to Shenzhen People’s Hospital from June 2014 to June 2018 were divided into routine operation group and neuronavigation endoscopy assistant group according to the application of surgical equipment. One week after the operation,the patients in the two treatment groups underwent CT reexamination to compare the recurrence of hematoma,residual hematoma and intracranial pneumatosis. One month after operation,CT was performed to compare the recurrence and residual of hematoma. Results One week after operation,the patients underwent CT reexamination. In the routine operation group,19 cases had partial hematoma residue and 45 cases had hematoma disappearance. In the neuronavigation endoscopy-assisted group,7 cases of partial hematoma remained and 45 cases of hematoma disappeared. The difference was significant (P=0.037). In the conventional operation group,there were 6 cases of subdural effusion and pneumocele,and 58 cases of no effusion and pneumocele. In neuronavigation endoscopy-assisted group,4 cases had subdural effusion and pneumocele,48 cases had no effusion and pneumocele. There was no significant difference (P=0.748). One month after operation,the patients underwent CT reexamination. In the routine operation group,11 cases had hematoma residual or recurrence,and 53 cases had hematoma disappearance. In the neuronavigation endoscopy-assisted group,there were 3 cases of hematoma residual or recurrence,and 49 cases of hematoma disappeared. The difference was significant (P=0.038). Conclusion The application of neuronavigation and endoscopy-assisted drilling and drainage for chronic subdural hematoma may improve the complete clearance rate of hematoma and reduce the recurrence rate of long-term hematoma,which has certain application value.