神经内镜血肿清除术与软通道引流术治疗慢性硬膜下血肿效果比较

Efficacy of neuroendoscopic hematoma removal versus soft channel drainage for chronic subdural hematoma

目的比较神经内镜血肿清除术与软通道引流术治疗慢性硬膜下血肿(CSDH)的临床效果及对患者神经功能、生活质量的影响。方法回顾性分析解放军陆军第七十二集团军医院2018年2月至2019年12月收治的CSDH患者97例的临床资料,根据手术方式的不同分为A组(n=48,给予软通道引流术治疗)和B组(n=49,给予神经内镜血肿清除术治疗),比较两组患者临床指标、神经功能、生活质量及并发症发生率。结果B组手术时间、住院时间、血肿消失时间分别为(31.32±2.18)min、(8.16±1.32)d、(7.45±1.49)d,均短于A组的(35.15±4.32)min、(13.18±1.56)d、(11.32±1.88)d,均差异有统计学意义(t=5.53、17.12、11.25,均P<0.001)。术后3个月,两组健康调查简表(SF-36)各维度评分均升高,B组生理机能、躯体疼痛、生理职能、一般健康状况、社会功能、精力、情感职能、精神健康评分为(84.94±7.25)分、(84.02±6.29)分、(82.85±8.16)分、(84.36±9.15)分、(83.51±10.39)分、(82.68±8.36)分、(84.93±10.15)分、(86.12±9.13)分,均高于A组的(62.68±5.47)分、(71.39±7.42)分、(69.51±6.39)分、(72.68±7.36)分、(72.81±8.15)分、(73.12±10.13)分、(77.91±9.52)分、(75.32±7.51)分,均差异有统计学意义(t=19.82、18.34、19.75、16.71、17.94、20.57、18.22、16.44,均P<0.001)。术后7 d,B组神经营养因子(NGF)、神经元特异性烯醇化酶(NSE)、硫化氢(H2S)、S100B蛋白分别为(42.53±6.09)μg/L、(6.52±2.79)μg/L、(203.17±15.03)μmol/L、(0.25±0.05)μg/L,均低于A组的(67.38±7.42)μg/L、(9.18±2.27)μg/L、(242.79±14.08)μmol/L、(0.36±0.07)μg/L,均差异有统计学意义(t=17.94、5.12、13.33、8.86,均P<0.001)。B组并发症发生率为8.16%(4/49),A组并发症发生率为18.75%(9/48),两组差异无统计学意义(χ^(2)=2.22,P=0.136)。结论与软通道引流术相比,CSDH患者采用神经内镜血肿清除术,临床指标、神经功能及生活质量方面的改善效果显著,且安全性较好,具有一定的临床应用价值和创新性。

Objective To investigate the clinical efficacy of neuroendoscopic hematoma removal versus soft channel drainage in the treatment of chronic subdural hematoma(CSDH)and their effects on neurological function and quality of life.Methods The clinical data of 97 patients with CSDH who received treatment between February 2018 and December 2019 were retrospectively analyzed.These patients were divided into group A(n=48,soft channel drainage)and group B(n=49,neuroendoscopic hematoma removal)according to different surgical methods.Clinical indicators,neurological function,quality of life,and incidence of complications were compared between groups A and B.Results Operative time,length of hospital stay,and latency to hematoma disappearance in group B were(31.3±2.18)minutes,(8.16±1.32)days,(7.45±1.49)days,which were significantly shorter than those in group A[(35.15±4.32)minutes,(13.18±1.56)days,(11.32±1.88)days,t=5.53,17.12,11.25,all P<0.001].At 3 months after surgery,the score of each dimension of SF-36 in each group was increased.The scores of physiological functioning,bodily pain,mental health,general health perceptions,social role functioning,vitality,role limitations due to emotional health,role limitations due to physical health in group B were(84.94±7.25)points,(84.02±6.29)points,(82.85±8.16)points,(84.36±9.15)points,(83.51±10.39)points,(82.68±8.36)points,(84.93±10.15)points,(86.12±9.13)points,which were significantly higher than those in group A[(62.68±5.47)points,(71.39±7.42)points,(69.51±6.39)points,(72.68±7.36)points,(72.81±8.15)points,(73.12±10.13)points,(77.91±9.52)points,(75.32±7.51)points,t=19.82,18.34,19.75,16.71,17.94,20.57,18.22,16.44,all P<0.001].At 7 days after surgery,neurotrophic factor,neuron specific enolase,hydrogen sulfide and S100B protein levels in group B were(42.53±6.09)μg/L,(6.52±2.79)μg/L,(203.17±15.03)μmol/L,(0.25±0.05)μg/L,respectively,which were significantly lower than those in group A[(67.38±7.42)μg/L,(9.18±2.27)μg/L,(242.79±14.08)μmol/L,(0.36±0.07)μg/L,t=17.94,5.12,13.33,8.86,all P<0.001].There was no significant difference in the incidence of complications between group B and group A[8.16%(4/49)vs.18.75%(9/48),χ^(2)=2.22,P=0.136].Conclusion Compared with soft channel drainage,neuroendoscopic hematoma removal can better improve clinical indicators,neurological function,and quality of life in patients with CSDH,and is highly safe Neuroendoscopic hematoma removal is of certain clinical application value and innovation.