分隔型慢性硬膜下血肿不同手术方式疗效及复发危险因素分析

Efficacy of different surgical methods and risk factors of recurrence for septated chronic subdural hematoma

目的比较神经内镜辅助小骨窗开颅冲洗引流术和小骨窗开颅冲洗引流术治疗分隔型慢性硬膜下血肿的疗效,并探讨分隔型慢性硬膜下血肿术后复发的危险因素。方法回顾分析2015年3月至2020年9月在本院神经外科诊断为分隔型慢性硬膜下血肿73例患者临床资料,按不同手术方式分为内镜组(神经内镜辅助小骨窗开颅冲洗引流术)32例和常规组(小骨窗开颅冲洗引流术)41例。分析两组患者临床特征、不同手术方式疗效、影响血肿复发的临床相关危险因素。结果两组患者术前临床特征无明显差异;两组患者术后并发症发生率、中线改善程度、术后神经功能恢复情况评分(Modified Rankin scale,MRS)、血肿复发率及死亡率无明显差异;内镜组患者手术时间明显长于常规组(P<0.01);二元Logistic回归分析显示:术前抗凝治疗是术后血肿复发的危险因素(P<0.05)。结论相对于小骨窗开颅冲洗引流术治疗分隔型慢性硬膜下血肿,神经内镜辅助未能进一步提高其治疗效果;术前抗凝药物使用可能是分隔型慢性硬膜下血肿复发的危险因素。

Objective To compare the efficacy of septated chronic subdural hematoma by small bone window craniotomy with or without neuroendoscopy,and to investigate risk factors of recurrence.Methods The clinical data of 73 patients diagnosed as septated chronic subdural hematoma in our department from March 2015 to September 2020 were collected and retrospectively analyzed.According to different surgical methods,the patients were divided into endoscopic group(n=32,small bone window craniotomy with aid of neuroendoscopy)and general group(n=41,small bone window craniotomy without neuroendoscopy).Clinical features,efficacy of different surgical methods,and risk factors for recurrence were analyzed.Results There were no notable differences in preoperative clinical features,postoperative complications,improvement of midline shift,postoperative modified Rankin scale(MRS)score,recurrence rate and mortality between the 2 groups.But statistical difference was seen in the operative time between them(P<0.01).Binary logistic regression analysis indicated that preoperative anticoagulant treatment was a risk factor for postoperative recurrence(P<0.05).Conclusion Neuroendoscopy did not improve the operative effectiveness of septated chronic subdural hematoma when compared with small bone window craniotomy.Preoperative anticoagulant may be a risk factor for its recurrence.