硬质神经内镜辅助手术治疗慢性硬膜下血肿的临床疗效

Clinical efficacy of surgery for chronic subdural hematoma assisted by rigid neuroendoscope

摘要:

目的??探讨硬质神经内镜辅助手术治疗慢性硬膜下血肿（CSDH）的临床疗效与操作技巧。方法?回顾性分析2009年8月-2015年12月采用血肿抽吸冲洗术治疗的161例CSDH患者的临床资料，其中74例采用硬质神经内镜辅助手术（内镜组），同期的另87例采用常规钻颅抽吸冲洗术治疗（常规组）。两组患者的年龄分布、头部创伤后病程、双侧血肿比率和血肿量等一般资料比较，差异均无统计学意义（P >0.05），具有可比性。记录两组的手术时间、操作相关并发症、术后即刻血肿完全清除率以及术后住院时间、血肿复发率的情况。结果?虽然内镜组的手术时间长于常规组，但操作相关并发症、术后即刻血肿完全清除率、术后住院时间及血肿复发率均低于常规组。内镜组的手术时间为（112.68±34.86）min，常规组为（74.11±28.23）min，差异有统计学意义（t =7.75，P =0.000）。内镜组的术后住院时间为（8.23±2.01）d，常规组为（10.79±5.02）d，差异有统计学意义（t =-4.12，P =0.000）。内镜组无手术相关并发症，常规组有1例出现脑内血肿及运动性失语。内镜组的术后即刻血肿清除率为98.65%（73/74），常规组为86.21%（75/87），差异有统计学意义（χ2=8.34，P =0.004）。内镜组的术后血肿复发率为1.35%（1/74），常规组为18.39%（16/87），差异有统计学意义（χ2=12.29，P =0.000）。两组患者出院后均进行门诊随访，随访时间6～38个月，平均30.06个月；17例在随访期间诊断为血肿复发，其中15例再次接受手术治疗后治愈，2例口服阿托伐他汀后治愈。结论?硬质神经内镜辅助手术治疗CSDH简单、安全、有效，优于传统的钻孔抽吸冲洗术。自制的头端可弯曲软头吸引器是进行此类手术的有效工具。

Abstract:

Objective?To discuss the clinical efficacy of surgery for chronic subdural hematoma assisted by rigid neuroendoscope and its surgical techniques.?Methods?Clinical data of 161 patients with chronic subdural hematoma from August 2009 to December 2015 was analyzed retrospectively. 74 of them experienced surgeries assisted by rigid neuroendoscope (endoscope group) and other 87 cases were operated without neuroendoscope (routine group) during the same period.?Results?Although there were significant difference in operative duration between the two groups, complications, ratio of total removal of hematoma after surgery, postoperative inpatient duration and recurrent rate of hematoma were more advantageous in endoscope group. The operative duration of endoscope group with (112.68 ± 34.86) min was longer than that of routine group with (74.11 ± 28.23) min (t = 7.75, P = 0.000), while the postoperative inpatient duration of endoscope group with (8.23 ± 2.01) d was shorter than that of another group with (10.79 ± 5.02) d (t = -4.12, P = 0.000). There were no surgical associated complications in endoscope group, but 1 patient in routine group experienced intracerebral hematoma of frontal lobe and associated aphemia. Total removal of hematoma was confirmed in endoscope group with 98.65% (73/74), which was higher than that in routine group with 86.21% (75/78) (χ2 = 8.34, P = 0.004). Hematoma recurrence was found in 16 cases of routine group (18.39%), but more superiority in endoscope group with 1.35% (χ2 = 12.29, P = 0.000). Outpatient follow-up was carried out in all patients from 6 to 38 months with an average duration of 30.06 months. In 17 cases with recurrent hematoma during follow-up, 15 of them were cured by a second surgery, and another 2 patients were cured by atorvastatin.?Conclusion?As a simple, safe and effective technique, the application of rigid neuroendoscope during surgery for chronic subdural hematoma is more advantage than routine surgery. A self-made suction with adjustable soft curved tip is suitable for such procedure.