神经内镜内技术治疗亚急性-慢性和慢性分隔硬膜下血肿的临床研究

doi:10.3969/j.issn.1002-1949.2018.08.002

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摘要目的探讨神经内镜内技术(INET)在治疗亚急性-慢性和慢性分隔硬膜下血肿中的安全性、有效性和临床应用价值。方法采用非随机同期对照的研究方法将2015-05~2018-04符合纳入标准的74例患者分成INET治疗组（INET组）35例和钻孔引流治疗组（对照组）39例。记录并比较两组间的手术时间、硬膜下引流管（SDT）放置时间、颅内感染率及术后随访1个月时的Bender分级和6个月的血肿复发率。建立多参数Logistic回归模型，分析6个月内与复发相关的危险因素。结果 INET组手术时间长于对照组［（64.4±13.6）min vs. (44.1±10.8)min，P=0.00］，但其术后随访6个月内的血肿复发率（2.9% vs. 23.0%，P=0.04）和SDT放置时间均低于对照组［(2.1±0.7)d vs. (3.9±0.8)d,P=0.00］；颅内感染率在两组间比较差异无统计学意义（0.0 vs. 5.1%，P=0.52）。随访1个月时的Bender分级总体有效率（100% vs. 89.7%，P=0.15）两组间比较差异无统计学意义，但恢复至Bender 0级无症状患者的比率INET组高于对照组（94.2% vs. 76.9%，P=0.04）。多参数Logistic回归分析显示，应用INET手术(OR 3.62, 95%CI1.202~10.911, P=0.02)、年龄在65岁及以下(OR1.65, 95%CI1.051~2.602, P=0.03)和单侧硬膜下血肿(OR1.61, 95%CI 1.067~2.418, P=0.02)是术后复发率降低的独立影响因素。结论 INET能够降低亚急性-慢性和慢性分隔硬膜下血肿的术后复发率，改善临床预后，是治疗该类疾病的一种安全、有效的新手术方法。

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	杜波
	单爱军
	李超
	彭玉平
	钟贤良
	王进
	张玉娟

关键词 ：神经内镜内技术(INET), 透明导管鞘, 慢性硬膜下血肿(cSDH), 预后

基金资助:广东省医学科学基金项目（A2016545）；深圳市卫计委临床研究项目（SZLY2018007）；南方医科大学科研创新项目（KJ20161115）；深圳市科创委项目（JCYJ20150403101028210）；深圳市卫计委临床技术研究与转化类项目（201601013,201506009）

通讯作者: 张玉娟（1981-），女，硕士，副主任医师，E-mail：jztrauma@126.com。

作者简介: 杜波（1982-），男，博士，副主任医师，E-mail：zyj_db@163.com。

引用本文:

杜波，单爱军，李超，彭玉平，钟贤良，王进，张玉娟. 神经内镜内技术治疗亚急性-慢性和慢性分隔硬膜下血肿的临床研究[J]. 中国急救医学, 2018, 38(8): 654-659.
Du Bo, Shan Ai-jun, Li Chao, Peng Yu-ping, Zhong Xian-liang, Wang Jin, Zhang Yu-juan. A clinical study of intra-neuroendoscopic technique in treating subacute-chronic and chronic septal subdural hematoma. Chinese Journal of Critical Care Medicine, 2018, 38(8): 654-659.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2018.08.002 或 http://www.cnemergency.org.cn/CN/Y2018/V38/I8/654

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