微创穿刺引流术与神经内镜下血肿清除术治疗慢性硬膜下血肿临床效果的对比研究

摘要

目的 比较微创穿刺引流术与神经内镜下血肿清除术治疗慢性硬膜下血肿的临床效果.方法 选取2013年5月-2016年12月涿州市医院收治的慢性硬膜下血肿患者103例,随机分为对照组51例和观察组52例.对照组患者采用微创穿刺引流术,观察组患者采用神经内镜下血肿清除术,比较两组患者手术情况(包括血肿清除率、术中出血量及手术时间)、临床效果、手术前后神经功能指标〔包括血清神经元特异性烯醇化酶(NSE)、神经营养因子(NGF)、S100B蛋白及硫化氢(H2S)水平〕及并发症、死亡情况.结果 观察组患者血肿清除率高于对照组,术中出血量少于对照组,手术时间短于对照组(P<0.05).两组患者临床效果比较,差异无统计学意义(P>0.05).术前两组患者血清NSE、NGF、S100B蛋白及H2S水平比较,差异无统计学意义(P>0.05);术后观察组患者血清NSE、NGF、S100B蛋白及H2S水平低于对照组(P<0.05).两组患者硬膜下出血、颅内积气、颅内感染、脑脊液漏液发生率及病死率比较,差异无统计学意义(P>0.05).结论 微创穿刺引流术与神经内镜下血肿清除术治疗慢性硬膜下血肿的临床效果相当,安全性相似,但神经内镜下血肿清除术能更有效地提高血肿清除率、减少术中出血量、缩短手术时间、改善患者神经功能.%Objective To compare the clinical effect on chronic subdural hematoma between minimally invasive puncture drainage and neuroendoscopic hematoma evacuation.Methods A total of 103 patients with chronic subdural hematoma were selected in Zhuozhou Hospital of Hebei Province from May 2013 to December 2016,and they were randomly divided into control group(n=51)and observation group(n=52).Patients of control group received minimally invasive puncture drainage,while patients of observation group received neuroendoscopic hematoma evacuation,hematoma clearance rate,intraoperative blood loss,duration of operation,clinical effect,index of neurological function(including serum levels of NSE,NGF,S100B protein and H2S)before and after treatment,incidence of complications and death status were compared between the two groups.Results Hematoma clearance rate of observation group was statistically significantly higher than that of control group,intraoperative blood loss of observation group was statistically significantly less than that of control group,and duration of operation of observation group was statistically significantly shorter than that of control group(P<0.05).No statistically significant differences of clinical effect was found between the two groups(P>0.05).No statistically significant differences of serum level of NSE,NGF,S100B protein or H2S was found between the two groups before operation(P>0.05),while serum levels of NSE,NGF,S100B protein and H2S of observation group were statistically significantly lower than those of control group after treatment(P<0.05).No statistically significant differences of incidence of subdural hemorrhage,intracranial pneumatosis,intracranial infection,cerebrospinal leak or fatality rate was found between the two groups(P>0.05).Conclusion Minimally invasive puncture drainage has similar clinical effect and safety with neuroendoscopic hematoma evacuation in treating chronic subdural hematoma,but neuroendoscopic hematoma evacuation can more effectively improve the hematoma clearance rate and neurological function,reduce the intraoperative blood loss,shorten the duration of operation.