内镜下血肿清除治疗非等密度慢性硬脑膜下血肿和亚急性硬脑膜下血肿的疗效分析

Analysis of therapeutic effect of endoscopic hematoma removal for non-isodense chronic subdural hematoma and subacute subdural hematoma

摘要:

目的 探讨内镜下血肿清除治疗非等密度慢性硬脑膜下血肿和亚急性硬脑膜下血肿的有效性和安全性。方法 选取2019年6月－2022年6月该院接受内镜手术的非等密度慢性硬脑膜下血肿和亚急性硬脑膜下血肿患者18例。分析血肿清除率、术后中线偏移复位情况、手术时间、术中出血量、术后复发率、不同时点格拉斯哥昏迷评分（GCS）和改良Rankin评分（mRS）等指标。结果 手术时间为（147.89±10.29）min，术中出血量为（130.52±18.42）mL。18例患者术前血肿平均体积为（111.91±34.25）mL，术后第1天复查CT提示：16例血肿全部清除，2例血肿绝大部分清除，血肿清除率为88.89%。颅脑CT提示：术前中线平均偏移为（11.49±3.23）mm，术后第1天中线复位至（6.19±2.61）mm，差异有统计学意义（P < 0.01）；术后1个月16例中线居中，2例中线偏移1.21和2.23 mm，术后1个月中线复位率为88.89%；术后半年，18例患者中线全部居中，中线复位率为100.00%。18例患者术后均无再出血，术后并发硬脑膜下积液1例，服药后积液吸收，术后随访半年，18例患者均未复发。入院时GCS为（14.06±2.46）分，出院时提高至（15.00±0.00）分，差异有统计学意义（P < 0.05）；入院时mRS为（3.17±1.26）分，出院时降低至（0.56±0.02）分，差异有统计学意义（P < 0.05）。结论 内镜下行非等密度慢性硬脑膜下血肿和亚急性硬脑膜下血肿清除术，是一种安全、有效的血肿清除方法，在达到大骨瓣开颅手术效果的同时，还可减少手术并发症和术后复发，且侵袭性较小。值得临床推广应用。

Abstract:

Objective To investigate the efficacy and safety of endoscopic hematoma evacuation in treatment of non-isodense chronic subdural hematoma and subacute subdural hematoma.Method From June 2019 to June 2022, endoscopic surgery was performed on 18 cases of non-isodense chronic subdural hematoma and subacute subdural hematoma. Then analyze the indicators such as hematoma clearance rate, postoperative midline deviation reduction, surgical time, intraoperative blood loss, postoperative recurrence rate, Glasgow coma score (GCS) and modified Rankin scale (mRS) at different times.Result The average surgical time was (147.89 ± 10.29) min, the intraoperative blood loss was (130.52 ± 18.42) mL. The average preoperative hematoma volume of 18 patients was (111.91 ± 34.25) mL, on the first day after surgery, CT scan showed that all the 16 hematoma cases were cleared, and the majority of 2 hematoma cases were cleared, the average hematoma clearance rate was 88.89%. Craniocerebral CT showed an average midline displacement of (11.49 ± 3.23) mm before surgery, which returned to (6.19 ± 2.61) mm on the first day after surgery, the difference was statistically significant (P < 0.01); At 1 month after surgery, 16 patients had a median midline displacement, while 2 patients had a median midline displacement of 1.21 and 2.23 mm, the median line regression rate was 88.89% at 1 month after surgery; 6 months after surgery, all the 18 patients had a median midline displacement, and the median line regression rate was 100.00%. All the 18 patients did not experience any further bleeding after surgery, one patient developed subdural effusion after surgery, which was absorbed after taking medication. After a follow-up of six months, all the 18 patients did not recur. The GCS on admission was (14.06 ± 2.46), which improved to (15.00 ± 0.00) at discharge, with a statistically significant difference (P < 0.05); mRS on admission was (3.17 ± 1.26), and decreased to (0.56 ± 0.02) at discharge, with statistical significance (P < 0.05).Conclusion Endoscopic removal of chronic and subacute subdural hematomas with non-isodense is a safe and effective method of hematoma removal. While achieving the effect of large bone flap craniotomy, it can significantly reduce the surgical complications and postoperative recurrence, have a less invasive. It is worthy clinical application.