脑膜中动脉介入栓塞治疗慢性硬膜下血肿的临床研究

Clinical Study of Interventional Embolization of Middle Meningeal Artery for Chronic Subdural Hematoma

目的:研究慢性硬膜下血肿(CSDH)治疗中脑膜中动脉介入栓塞的临床效果。方法:回顾性选取2019年2月—2022年7月赣州市人民医院114例CSDH患者临床资料,根据是否接受脑膜中动脉(MMA)栓塞治疗分为传统治疗组(81例,82个病侧)和MMA栓塞组(33例,35个病侧),以改良Rankin量表(mRS)评估预后,比较两组血肿复发率、挽救性手术率、手术并发症、随访结果。结果:MMA栓塞组CSDH进展、复发率[2.9%(1/35)]低于传统治疗组[22.0%(18/82)],挽救性手术率[2.9%(1/35)]低于传统治疗组[18.3%(15/82)],差异均有统计学意义(P=0.012、0.037)。在术后3个月随访中,MMA栓塞组CSDH吸收率[60.0%(21/35)]高于传统治疗组[35.4%(29/82)],差异有统计学意义(P=0.037),两组手术并发症发生率[0(0/33)与1.2%(1/81)]、预后良好率(mRS≤2分)[100%(33/33)与96.3%(78/81)]、死亡率[0(0/33)与1.2%(1/81)]差异均无统计学意义(P>0.05)。结论:MMA栓塞是治疗CSDH一种安全的方法,相对于传统治疗方法血肿进展、复发率低。

Objective:To study the clinical effect of chronic subdural hematoma(CSDH)treated by middle meningeal artery embolization.Method:The clinical data of 114 patients with CSDH from February 2019 to July 2022 in Ganzhou People's Hospital were retrospectively selected.According to whether to accept the treatment of middle meningeal artery(MMA)embolization,they were divided into the traditional treatment group(81 cases,82 diseased sides)and the MMA embolization group(33 cases,35 diseased sides).The prognosis was evaluated by modified Rankin scale(mRS),and the recurrence rate of hematoma,salvage surgery rate,surgical complications and follow-up results were compared between the two groups.Result:The progression and recurrence rate of CSDH in MMA embolization group[2.9%(1/35)]was lower than that[22.0%(18/82)]in traditional treatment group,and the salvage surgery rate[2.9%(1/35)]was lower than that[18.3%(15/82)]in traditional treatment group,and the differences were statistically significant(P=0.012,0.037).After 3 months of follow-up,the absorption rate of CSDH in MMA embolization group [60.0% (21/35)] was higher than that [35.4% (29/82)] in traditional treatment group, the difference was statistically significant (P=0.037). There were no significant differences in the incidence of surgical complications [0 (0/33) vs 1.2% (1/81)], the rate of good prognosis (mRS ≤2 points) [100% (33/33) vs 96.3% (78/81)], and the mortality [0 (0/33) vs 1.2% (1/81)] between the two groups (P>0.05). Conclusion: MMA embolization is a safe method for treating CSDH, with a lower progression and recurrence rates of hematoma compared to traditional treatment methods.