慢性硬膜下血肿经神经内镜或钻孔引流治疗效果及安全性对比分析  

Comparative analysis of efficacy and safety of chronic subdural hematoma treated by neuroendoscopy or burr hole drainage

作　　者：陈晟[1] 程浩[1] 徐昌林 黄晓娇 高涢 李毅[1] CHEN Sheng;CHENG Hao;XU Changlin;HUANG Xiaojiao;GAO Yun;LI Yi(The Third Clinical Medical College of the Three Gorges University,Gezhouba Central Hospital of Sinopharm,Yichang 443002,China)

机构地区：[1]三峡大学第三临床学院国药葛洲坝中心医院,湖北宜昌443002

出　　处：《中国实用神经疾病杂志》2022年第10期1221-1225,共5页Chinese Journal of Practical Nervous Diseases

摘　　要：目的探讨慢性硬膜下血肿(CSDH)经神经内镜或钻孔引流治疗效果及安全性。方法回顾性分析三峡大学第三临床学院2019-08—2021-08收治的63例CSDH患者的临床治疗资料,根据资料中治疗方法不同进行分组,其中观察组(28例)进行神经内镜治疗,对照组(35例)进行钻孔引流治疗。采用酶联免疫吸附法检测血清神经生长因子(NGF)、神经元特异性烯醇化酶(NSE)、S100B蛋白水平。比较2组患者的手术期间相关指标、临床疗效、血清神经功能相关指标、术后并发症以及复发情况。结果对照组的手术时间[(33.68±5.43)min]短于观察组[(37.56±5.52)min],住院时间[(10.16±1.23)d]长于观察组[(7.05±1.01)d],并且术后第1天、4天、7天、1个月的血肿清除率[(93.47±3.64)%,(92.19±3.62)%,(68.81±3.21)%,(65.76±3.15)%]低于观察组[(97.82±3.67)%,(95.16±3.65)%,(95.86±3.63)%,(95.58±6.64)%],P<0.05。对照组和观察组的总有效率分别为88.57%、96.42%,差异无统计学意义(P>0.05)。治疗后,2组患者血清NGF、NSE、S100B蛋白水平均降低,且观察组低于对照组(P<0.05)。观察组并发症发生率与复发率(10.71%,3.57%)明显低于对照组(31.43%,22.86%),P<0.05。结论经神经内镜与钻孔引流两种手术方法均能够有效治疗CSDH。与钻孔引流术相比,神经内镜血肿清除术的血肿清除率更高,并且能更好的促进神经功能恢复,降低术后并发症以及血肿复发率。Objective To investigate the efficacy and safety of neuroendoscopy or burr hole drainage for chronic subdural hematoma(CSDH).Methods The clinical treatment data of 63 patients with CSDH admitted to our hospital from August 2019 to August 2021 were retrospectively analyzed,and they were divided into groups according to different treatment methods in the data.Among them,the observation group(28 cases)received neuroendoscopy,and the control group(35 cases)underwent drilling and drainage treatment.Serum nerve growth factor(NGF),neuron-specific enolase(NSE)and S100B protein levels were detected by enzyme-linked immunosorbent assay.The relative indicators during operation,clinical efficacy,serum neurological function-related indicators,postoperative complications and recurrence were compared in two groups.Results The operation time of the control group[(33.68±5.43)min]was shorter than that of the observation group[(37.56±5.52)min],the hospital stay[(10.16±1.23)days]was longer than that of the observation group[(7.05±1.01)days],and the hematoma clearance rate on the 1st day,4th day,7th day and 1 month after operation[(93.47±3.64)%,(92.19±3.62)%,(68.81±3.21)%,(65.76±3.15)%]were lower than those in the observation group[(97.82±3.67)%,(95.16±3.65)%,(95.86±3.63)%,(95.58±6.64)%],P<0.05.The total effective rates of the control group and the observation group were 88.57%and 96.42%,respectively,with no significant difference(P>0.05).After treatment,the serum NGF,NSE and S100B protein levels in the two groups were decreased,and the serum NGF,NSE and S100B protein levels in observation group were lower compared with control group(P<0.05).The incidence of complications and recurrence in the observation group(10.71%,3.57%)were significantly lower compared with control group(31.43%,22.86%),P<0.05.Conclusion Both neuroendoscopy and burr hole drainage can effectively treat CSDH.Compared with burr hole drainage,neuroendoscopic hematoma removal has a higher hematoma clearance rate,which can better promote the recovery of ner

关 键 词：慢性硬膜下血肿 神经内镜 钻孔引流术 血清 神经元特异性烯醇化酶 神经生长因子 

分 类 号：R651.1[医药卫生—外科学]