硬质神经内镜辅助手术治疗慢性硬膜下血肿的临床疗效

发布时间：2018-05-23 21:23

本文选题：慢性硬膜下血肿 + 硬质神经内镜　；参考：《中国内镜杂志》2017年06期

【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(P0.05),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(χ~2=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(χ~2=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 evaluate the clinical efficacy and operative skills of rigid endoscopy assisted surgery for chronic subdural hematoma (CSDH). Methods the clinical data of 161 patients with CSDH who were treated with hematoma aspiration and washing from August 2009 to December 2015 were retrospectively analyzed. 74 cases were treated with rigid endoscopic assisted surgery (endoscopic group) and 87 cases were treated with routine drilling aspiration and irrigation (routine group). The age distribution, the course of head trauma, bilateral hematoma ratio and hematoma volume in the two groups were not significantly different (P 0.05). The operation time, operative complications, complete hematoma clearance rate, postoperative hospitalization time and hematoma recurrence rate were recorded in both groups. Results although the operative time in the endoscopic group was longer than that in the routine group, the operative complications, the complete clearance rate of hematoma immediately after operation, the postoperative hospitalization time and the recurrence rate of hematoma were lower than those in the routine group. The operative time of endoscopic group was 112.68 卤34.86 min, and that of routine group was 74.11 卤28.23 min. The difference was statistically significant. The postoperative hospitalization time of the endoscopic group was 8.23 卤2.01d, and that of the routine group was 10.79 卤5.02d. The difference was statistically significant (P < 0.05). There were no operative complications in the endoscopic group, and one patient in the routine group had intracerebral hematoma and motor aphasia. The immediate hematoma clearance rate in the endoscopic group was 98.65% 73 / 74 and that in the routine group was 86.21% 75 / 87% (蠂 ~ (2 / 2) 8.34% P ~ (0.004). The recurrence rate of postoperative hematoma in the endoscopic group was 1.35 / 74, and that in the routine group was 18.39 / 87. The difference was statistically significant (蠂 ~ (2 / 2) 12.29 / P ~ (0.000). The patients in both groups were followed up for 6 ~ 38 months (mean 30.06 months), 17 cases were diagnosed as hematoma recurrence during the follow-up period, 15 cases were cured after reoperation and 2 cases were cured after oral Atto vastatin. Conclusion rigid endoscopy assisted surgery is simple, safe and effective in the treatment of CSDH. The self-made head-end flexible head attractor is an effective tool for this kind of operation.
【作者单位】：苏州大学附属第二医院神经外科;
【分类号】：R651.15

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