经眉弓锁孔入路神经内镜手术清除外伤性单侧额叶血肿的效果

Clinical efficacy of neuroendoscopic surgery through eyebrow arch keyhole approach for patients with traumatic unilateral frontal hematoma

目的探讨经眉弓锁孔入路神经内镜手术清除外伤性单侧额叶血肿的效果。方法回顾性分析2019年2月至2020年8月经眉弓锁孔入路神经内镜手术治疗的21例外伤性单侧额叶血肿的临床资料。术中应用神经内镜潜水技术清除血肿,应用PROLENE线皮内连续缝合切开。结果所有手术操作均顺利完成,无手术死亡病例。手术操作时间0.5~1 h,平均45 min。术后1 d,复查头颅CT显示血肿清除率>90%有19例,70%~90%有2例。术后无术区继发再出血,无继发严重脑水肿。术后5~10 d出院,平均7.6 d。眉弓切口缝合线拆除后,无线结反应、无切口愈合不佳及切口明显瘢痕形成。结论对于外伤性单侧额叶血肿,锁孔技术、神经内镜潜水技术联合PROLENE线皮内连续缝合技术,可以提高手术疗效,减少并发症,缩短住院时间,提高病人满意度,能达到最大的血肿清除效果和最佳的术后美容效果。

Objective To explore the effectiveness of neuroendoscopic surgery through the eyebrow arch keyhole approach for the patients with traumatic unilateral frontal hematoma.Methods A retrospective analysis was performed on the clinical data of 21 patients with traumatic unilateral frontal hematoma who underwent neuroendoscopic surgery via the eyebrow keyhole approach from February 2019 to August 2020.During the operation,the hematoma was removed by neuroendoscopic diving technique,and the incision was sutured intracutaneously with PROLENE thread.Results All surgical procedures were successfully completed,and there were no deaths due to the operation.The operation time ranged from 30 minutes to 1 hour,with an average of 45 minutes.The head CT 1 day after operation showed that the hematoma clearance rate was≥90%was achieved in 19 patients,and 70%~90%in 2.There was no secondary bleeding in the operation area,and no secondary severe cerebral edema.They were discharged 5~10 days after the operation,with an average of 7.6 days.After the suture of the brow arch incision was removed,there was no suture-line reaction,no poor incision healing and obvious scar formation of the incision.Conclusions For the patients with traumatic unilateral frontal lobe hematoma,keyhole technique,neuroendoscopic diving technique combined with PROLENE thread intradermal continuous suture technique can improve the surgical efficacy,reduce the postoperative complications,shorten the hospital stay,and improve the patient satisfaction.It can achieve the effect of the maximum hematoma removal and the best postoperative lineament.