选择性脑膜中动脉结扎在慢性硬脑膜下血肿钻孔引流术后疗效观察及影响因素分析  

Observation on the therapeutic effect and influencing factors of selective ligation of the middle meningeal artery after drilling and drainage surgery for chronic subdural hematoma

作　　者：樊玉良[1] 吴斌[2] 朱春雷[1] 赵小林[1] 赵义[1] 刘欢 Fan Yuliang;Wu Bin;Zhu Chunlei;Zhao Xiaolin;Zhao Yi;Liu Huan(Department of Neurosurgery,Beijing Geriatric Hospital,Beijing 100094,China;Neurological Ward 7,Sanbo Brain Hospital,Capital Medical University,Beijing 100093,China)

机构地区：[1]北京老年医院神经外科,北京100094 [2]首都医科大学三博脑科医院神经外科七病区,北京100093

出　　处：《中国医师进修杂志》2024年第9期835-839,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨选择性脑膜中动脉结扎在慢性硬脑膜下血肿钻孔引流术后疗效观察及影响因素分析。方法回顾性收集2018年10月至2021年1月在北京老年医院行常规钻孔引流术治疗慢性硬脑膜下血肿50例患者的临床资料作为对照组;2021年2月至2023年1月北京老年医院行常规钻孔引流术+脑膜中动脉结扎的慢性硬脑膜下血肿47例患者的临床资料为观察组。结果对照组和观察组各自术前、术后Markwalder评分系统-格拉斯哥昏迷评分(MGS-GCS)分级比较差异有统计学意义(χ^(2)=34.56、63.39,P<0.01)。两组术后MGS-GCS神经外科功能障碍分级比较差异有统计学意义(χ^(2)=4.34,P=0.037);观察组复发率低于对照组[10.6%(5/47)比28.0%(14/50)],差异有统计学意义(χ^(2)=4.63,P=0.031)。观察组减少复发的因素包括阿尔茨海默病、冠心病、男性、口服抗精神类药物、口服抗凝药物(χ^(2)=15.25、4.36、6.09、12.63和8.68,P<0.05)。结论慢性硬脑膜下血肿钻孔引流术中选择性结扎脑膜中动脉可以减少术后复发,尤其适用于阿尔茨海默病、冠心病、男性、口服抗精神类药物、口服抗凝药物患者;术前CT颅骨重建后修剪获取脑膜中动脉沟,可获取脑膜中动脉结扎体表定位,此手术安全,未见颅神经附加损伤。Objective To investigate the efficacy and influencing factors of selective ligation of the middle meningeal artery after drilling and drainage surgery for chronic subdural hematoma.Methods The clinical data of patients with chronic subdural hemorrhage who underwent routine drilling and drainage surgery in Beijing Geriatric Hospital from October 2018 to January 2021 were taken as the control group;The clinical data of patients with chronic subdural hemorrhage who underwent routine drilling and drainage surgery and ligation of the middle meningeal artery in the same hospital from February 2021 to January 2023 was taken as the observation group.Results Comparison of CSDH Markwalder grading scale and Glasgow coma scale(MGS-GCS)neurosurgical dysfunction grading before and after surgery between the control group and the observation group showed statistically significant differences(χ^(2)=34.56 and 63.39,P<0.01).There was statistically significant difference in the grading of postoperative MGS-GCS neurosurgical dysfunction between the control group and the observation group(χ^(2)=4.34,P=0.037);the recurrence rate of the observation group was lower than that of the control group:10.6%(5/47)vs.28.0%(14/50),with statistical differences(χ^(2)=4.63,P=0.031).The factors that reduce recurrence in the middle meningeal artery ligation group included Alzheimer disease coronary heart disease,males,oral antipsychotic and oral anticoagulant(χ^(2)=15.25,4.36,6.09,12.63 and 8.68;P<0.05).Conclusions Preliminary exploration has found that selective ligation of the middle meningeal artery during the drilling and drainage surgery for chronic subdural hematoma can reduce postoperative recurrence,especially suitable for patients with Alzheimer disease,coronary heart disease,males,oral antipsychotic and oral anticoagulant.After preoperative CT skull reconstruction and pruning to obtain the sulcus of the middle meningeal artery,the body surface localization of the ligation of the middle meningeal artery can be obtained.This surgery is saf

关 键 词：血肿 硬膜下 慢性 脑膜中动脉结扎 疗效观察 影响因素 

分 类 号：R651.1[医药卫生—外科学]