经额入路神经内镜手术在慢性硬膜下血肿治疗中的应用

Application of transfrontal neuroendoscopic surgery in the treatment of chronic subdural hematoma

摘要:

目的 评价经额入路神经内镜手术治疗慢性硬膜下血肿（CSDH）的疗效。方法 分析80例CSDH病例的临床资料，依据手术方式，分为传统顶结节钻孔外引流术组（钻孔引流组，n = 40），以及经额入路神经内镜下小骨窗血肿清除术组（神经内镜组，n = 40），比较两组患者治疗有效率、术后1个月血肿复发率、手术时间和术中出血量。结果 神经内镜组治疗有效率为95.0%，明显高于钻孔引流组的75.0%，神经内镜组术后1个月血肿复发率为5.0%，明显低于钻孔引流组的25.0%，神经内镜组手术时间为（54.1±7.5）min，较钻孔引流组的（40.7±9.4）min长，差异均有统计学意义（P < 0.05）。神经内镜组术中出血量为（30.1±4.5）mL，与钻孔引流组的（27.1±6.4）mL比较，差异无统计学意义（P > 0.05）。结论 采用经额入路神经内镜手术治疗CSDH，能明显提高手术疗效，且术后血肿复发率极低。值得应用于临床。

Abstract:

Objective To evaluate the efficacy of transfrontal neuroendoscopic surgery in the treatment of chronic subdural hematoma.Methods Analysis of clinical data of 80 cases of chronic subdural hematoma. According to the surgical method, 40 cases were divided into traditional external drainage of parietaltuber, 40 cases were divided into transfrontal neuroendoscopic small bone window hematoma removal. The treatment efficiency, hematoma recurrence rate, operation time and intraoperative blood loss were compared between the two groups.Results Treatment efficiency of neuroendoscopic group was 95.0%, significantly higher than drainage group 75.0%, hematoma recurrence rate one month after surgery of neuroendoscopic group was 5.0%, significantly lower than that in drainage group 25.0%, operation time of neuroendoscopic group was (54.1 ± 7.5) min, longer than that of drainage group (40.7 ± 9.4) min, the differences were statistically significant (P < 0.05). The intraoperative blood loss of neuroendoscopic group was (30.1 ± 4.5) mL, compared with (27.1 ± 6.4) mL in the drainage group, the difference was not statistically significant (P > 0.05).Conclusion Transfrontal neuroendoscopic surgery can significantly improve the efficacy of chronic subdural hematoma, and hematoma recurrence rate is extremely low. It is worthy of clinical application.