单侧慢性硬膜下血肿单孔与双孔钻孔引流术的疗效对比分析

Comparative analysis of the efficacy of single-hole and double-hole drilling drainage for unilateral chronic subdural hematoma

目的对比分析单孔与双孔钻孔引流术治疗单侧慢性硬膜下血肿(CSDH)的效果.方法回顾性分析2017年2月至2020年10月深圳市第二人民医院神经外科采用钻孔引流术治疗的118例单侧CSDH患者的临床资料,根据患者的手术方式分为单孔引流组(n=83,简称单孔组)与双孔引流组(n=35,简称双孔组).两组患者的性别分布、年龄、头部外伤史等术前基线资料的差异均无统计学意义(均P>0.05).比较两组患者的手术时长、术中出血量、术后并发症、症状和肌力改善情况、出院时格拉斯哥昏迷评分、住院时长、住院费用、术后3个月CSDH的复发情况等.结果两组患者的手术均顺利完成.单孔组与双孔组患者的症状改善率[96.1%(73/76)对比97.0%(32/33)]、肌力改善比例(27/41对比12/18)、出院时格拉斯哥昏迷评分[(14.84±0.75)分对比(14.97±0.17)分]及术后3个月CSDH复发率[3.6%(3/83)对比0]的差异均无统计学意义(均P>0.05).与单孔组比较,双孔组患者的手术时长[(87.7±26.9)min对比(48.1±14.9)min]、术中出血量[M(Q_(1),Q_(3))∶30(20,50)ml对比20(10,20)ml]、术后颅内积气量[15(12,30)ml对比5(3,5)ml]、住院时长[10(7,15)d对比7(4,12)d]和住院费用[33791(29476,37923)元对比22026(15682,30800)元]均增加,差异均具有统计学意义(均P<0.05).结论采用单孔与双孔钻孔引流术治疗的单侧CSDH患者的症状改善率和短期复发率相近,但采用单孔钻孔引流术的患者术中出血量和术后颅内积气量更少、住院时长更短、费用更低.

Objective To explore the efficacy of single versus double burr hole drainage in treating the chronic subdural hematoma(CSDH).Methods A retrospective analysis was performed on the clinical data of 118 patients with unilateral CSDH treated with burr hole drainage in the Department of Neurosurgery of Second People's Hospital of Shenzhen from February 2017 to October 2020.The patients were divided into single burr hole drainage group(n=83,referred to as the single-hole group)and the double burr hole drainage group(n=35,referred to as the double-hole group)according to the surgical method.There were no statistically significant differences in preoperative baseline data such as gender distribution,age,trauma history,etc.between the two groups of patients(all P>0.05).The two groups of patients were compared in terms of operation duration,intraoperative blood loss,postoperative complications,improvement in symptoms and muscle strength,Glasgow Coma Score at discharge,length of hospitalization,hospitalization costs,and recurrence rate of CSDH 3 months after surgery.Results The operations of both groups of patients were successfully completed.Between the two groups,there was no significant difference in the symptom improvement rate of patients[96.1%(73/76)vs.97.0%(32/33)],muscle strength improvement rate(27/41 vs.12/18),Glasgow Coma Score at discharge(14.84±0.75 points vs.14.97±0.17 points)and CSDH recurrence rate 3 months after surgery[3.6%(3/83)vs.0](all P>0.05).Compared with the single-hole group,the operation time of patients(87.7±26.9 min vs.48.1±14.9 min),intraoperative blood loss[M(Q_(1),Q_(3))∶30(20,50)ml vs.20(10,20)ml],postoperative intracranial gas volume[15(12,30)ml vs.5(3,5)ml],length of hospitalization[10(7,15)d vs.7(4,12)d]and hospitalization expenses[33791(29476,37923)yuan vs.22026(15682,30800)yuan]in the double-hole group all increased,and the differences were statistically significant(all P<0.05).Conclusions The symptom improvement rate and recurrence rate of patients with unilateral CSDH treated with single-hole and double-hole drilling drainage seem similar.Patients treated with single-hole drilling and drainage have less intraoperative bleeding,less postoperative intracranial pneumatosis,shorter hospital stay and less expenses.