慢性硬膜下血肿神经内镜与钻孔引流疗效对比分析

Efficacy analysis of neuroendoscopy and drill drainage in the treatment of chronic subdural hematoma

目的探讨神经内镜手术与钻孔引流手术对慢性硬膜下血肿(chronic subdural hematoma,CSDH)的疗效。方法回顾性分析144例CSDH病人的临床资料,按照手术方式不同分为内镜组60例,钻孔组84例,统计分析两组手术前后的临床资料。结果与钻孔组相比,内镜组术后残余血肿量更少,血肿清除率更高,留置引流管时间更短,术后Bender分级更优,但手术时间明显延长(P <0.05);两组平均住院时间无明显差异(P> 0.05)。内镜组引流管均放置准确,钻孔组引流管误置8例(9.5%),两组差异显著(P <0.05)。随访1~6个月,内镜组复发1例(1.7%),钻孔组复发9例(10.7%),两组术后复发率差异显著(P <0.05)。结论神经内镜手术具有清除率高、置管准确、拔管时间早、术后复发率低等优点,治疗CSDH是安全、有效的。

Objective To evaluate clinical efficacy of neuroendoscopy and drill drainage in the treatment of chronic subdural hematoma(CSDH). Methods Clinical data of 144 patients with CSDH were analyzed retrospectively, and the patients were divided into the endoscope group(n = 60) and drilling group(n = 84) according to the different surgical methods. The clinical data before and after surgery of the two groups were statistically analyzed. Results Compared with the drilling group, the endoscope group had less residual hematoma, higher hematoma clearance rate, shorter duration time of drainage tube, better Bender grading, but significantly longer operation time(all P < 0.05). There was no significant difference in the mean length of hospital stay between the two groups(P > 0.05). Drainage tubes in the endoscope group were placed accurately, but 8 patients with drainage tubes in the drilling group were misplaced, there was a significant difference between the two groups(P < 0.05). During a follow-up period of 1 to 6 months, 1 patient(1.7%) recurred in the endoscope group and 9(10.7%) in the drilling group, and there was a significant difference in the recurrence rate between the two groups(P < 0.05). Conclusions Neuroendoscopic surgery has the advantages of high evacuation rate, accurate catheterization, early extubation time and low postoperative recurrence rate, thus being safe and effective for CSDH.