陈晟;程浩;徐昌林;黄晓娇;高涢;李毅;

• 1:三峡大学第三临床学院国药葛洲坝中心医院

摘要(Abstract)：

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。

关键词(KeyWords)： 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

Abstract:

Keywords:

基金项目(Foundation):

作者(Authors): 陈晟;程浩;徐昌林;黄晓娇;高涢;李毅;

参考文献(References)：

• [1]HOFFMAN H,JALAL M S,BUNCH K M,et al.Management of chronic subdural hematoma with the subdural evacuating port system:Systematic review and meta-analysis[J].J Clin Neurosci,2021,86:154-163.DOI:10.1016/j.jocn.2021.01.039.
• [2]WANG H,WANG C,LI Z.Recurrent Bilateral Chronic Subdural Hematoma After Interventional Embolization Combined With Drilling and Drainage Treatment[J].J Craniofac Surg,2020,31(2):e171-e173.DOI:10.1097/SCS.0000000000006128.
• [3]李凯，刘志强，刘明.颅内血肿硬通道穿刺引流治疗慢性硬膜下血肿临床观察[J].中国实用神经疾病杂志，2021,24(11):972-977.DOI:10.12083/SYSJ.2021.10.028.
• [4]ICHIMURA S,TAKAHARA K,NAKAYA M,et al.Neuroendoscopic Technique for Recurrent Chronic Subdural Hematoma with Small Craniotomy[J].Turk Neurosurg,2020,30(5):701-706.DOI:10.5137/1019-5149.JTN.27918-19.4.
• [5]FANG H,ZHANG Z,LIU Y,et al.Rigid Neuroendoscopy Assisted Hematoma Resection Reduces the Recurrence Rate of Chronic Subdural Hematoma With Mixed Density:ARetrospective Analytic Cohort Study[J].Front Surg,2022,25;9:789118.DOI:10.3389/fsurg.2022.789118.
• [6]ZHUANG Y,JIANG M,ZHOU J,et al.Surgical Treatment of Bilateral Chronic Subdural Hematoma[J].Comput Intell Neurosci,2022,2022:2823314.DOI:10.1155/2022/2823314.
• [7]FAN Q.Pseudohypoxic Brain Swelling after Drilling and Drainage for Chronic Subdural Hematoma[J].J Neurol Surg A Cent Eur Neurosur,2021,82(1):87-89.DOI:10.1055/s-0040-1712500.
• [8]WU S,WANG H,WANG J,et al.Effect of Robot-Assisted Neuroendoscopic Hematoma Evacuation Combined Intracranial Pressure Monitoring for the Treatment of Hypertensive Intracerebral Hemorrhage[J].Front Neurol,2021,12:722924.DOI:10.3389/fneur.2021.722924.
• [9]DING H T,HAN Y,SUN D K,et al.Efficacy and safety profile of neuroendoscopic hematoma evacuation combined with intraventricular lavage in severe intraventricular hemorrhage patients[J].Brain Behav,2020,10(9):e01756.DOI:10.1002/brb3.1756.
• [10]FEGHALI J,YANG W,HUANG J.Updates in Chronic Subdural Hematoma:Epidemiology,Etiology,Pathogenesis,Treatment,and Outcome[J].World Neurosurg,2020,141:339-345.DOI:10.1016/j.wneu.2020.06.140.
• [11]YOKOYA S,NISHII S,TAKEZAWA H,et al.Organized Chronic Subdural Hematoma Treated with Middle Meningeal Artery Embolization and Small Craniotomy:Two Case Reports[J].Asian J Neurosurg,2020,15(2):421-424.DOI:10.4103/ajns.AJNS_341_19.
• [12]吴仰宗，徐云峰，林堃，等.轻型颅脑损伤后硬膜下积液演变为慢性硬膜下血肿的影响因素分析[J].中国实用神经疾病杂志，2021,24(9):775-780.DOI:10.12083/SYSJ.2021.11.007.
• [13]AROMATARIO M,TORSELLO A,D’Errico S,et al.Traumatic Epidural and Subdural Hematoma:Epidemiology,Outcome,and Dating[J].Medicina(Kaunas),2021,57(2):125.DOI:10.3390/medicina57020125.
• [14]HART R G,PEARCE L A,GORELICK P B,et al.Aspirin Use and Risk of Subdural Hematoma:Updated Meta-Analysis of Randomized Trials[J].J Stroke Cerebrovasc Dis,2021,30(8):105911.DOI:10.1016/j.jstrokecerebrovasdis.2021.105911.
• [15]RAUHALA M,HELéN P,HUHTALA H,et al.Chronic subdural hematoma-incidence,complications,and financial impact[J].Acta Neurochir (Wien),2020,162(9):2033-2043.DOI:10.1007/s00701-020-04398-3.
• [16]THAVARA B D,KIDANGAN G S,RAJAGOPALAWARRIER B.Comparative Study of Single Burr-Hole Craniostomy versus Twist-Drill Craniostomy in Patients with Chronic Subdural Hematoma[J].Asian J Neurosurg,2019,14(2):513-521.DOI:10.4103/ajns.AJNS_37_19.
• [17]GUO A S,LIN G S,XIE D H,et al.Effectiveness of Surgical Treatments for Basal Ganglia Hemorrhage and Imaging Factors Affecting Hematoma Evacuation Rate by Neuroendoscopic Surgery[J].J Neurol Surg A Cent Eur Neurosurg,2020,81(2):155-162.DOI:10.1055/s-0039-1698523.
• [18]ZHANG Y,SHAN A J,PENG Y P,et al.The intra-neuroendoscopic technique(INET):a modified minimally invasive technique for evacuation of brain parenchyma hematomas[J].World J Emerg Surg,2019,14:21.DOI:10.1186/s13017-019-0239-0.
• [19]YAGNIK K J,GOYAL A,VAN GOMPEL J J.Twist drill craniostomy vs burr hole drainage of chronic subdural hematoma:a systematic review and meta-analysis[J].Acta Neurochir(Wien),2021,163(12):3229-3241.DOI:10.1007/s00701-021-05019-3.
• [20]BAI J,ZHOU Y,SONG G,et al.Drilling off the Petrosal Apex and Opening the Upper Wall of Meckel’s Cave Are the Key Elements of Good Outcomes in the Treatment of Trigeminal Neuralgia Secondary to Petrous Apex Meningioma[J].J Korean Neurosurg Soc,2022,65 (3):479-488.DOI:10.3340/jkns.2021.0060.
• [21]ICHIMURA S,TAKAHARA K,NAKAYA M,et al.Neuroendoscopic hematoma removal with a small craniotomy for acute subdural hematoma[J].J Clin Neurosci,2019,61:311-314.DOI:10.1016/j.jocn.2018.11.043.
• [22]KATSUKI M,KAKIZAWA Y,NISHIKAWA A,et al.Lower total protein and absence of neuronavigation are novel poor prognostic factors of endoscopic hematoma removal for intracerebral hemorrhage[J].J Stroke Cerebrovasc Dis,2020,29(9):105050.DOI:10.1016/j.jstrokecerebrovasdis.2020.105050.
• [23]UCHIDA D,NAKATOGAWA H,YAMAZOE T,et al.Neuroendoscopic Surgery with a Combination of Image Detectable Sheath,Intraoperative Computed Tomography Scan,and Navigation System Improves Accuracy and Safety in Minimally Invasive Evacuation of Intracerebral Hematoma:Technical Note[J].World Neurosurg,2020,133:1-7.DOI:10.1016/j.wneu.2019.09.058.
• [24]ZHU T,JIANG S,YANG Z,et al.A neuroendoscopic navigation system based on dual-mode augmented reality for minimally invasive surgical treatment of hypertensive intracerebral hemorrhage[J].Comput Biol Med,2021,140:105091.DOI:10.1016/j.compbiomed.2021.105091.
• [25]ATSUMI H,BABA T,SUNAGA A,et al.Neuroendoscopic Evacuation for Spontaneous Cerebellar Hemorrhage Is a Safe and Secure Approach and May Become a Mainstream Technique[J].Neurol Med Chir(Tokyo),2019,59(11):423-429.DOI:10.2176/nmc.oa.2019-0108.
• [26]MIYATA M,NONAKA M,UENO K,et al.A ventricular catheter that migrated into the fourth ventricle successfully removed using a neuroendoscope[J].Br J Neurosurg.2021,26:1-4.DOI:10.1080/02688697.2021.1900782.
• [27]MARANESI M,BOITI C,ZERANI M.Nerve Growth Factor(NGF)and Animal Reproduction[J].Adv Exp Med Biol,2021,1331:277-287.DOI:10.1007/978-3-030-74046-7_19.