内镜下经小骨窗清除亚急性创伤性硬膜下血肿疗效分析

伊柯帆; 刘亚松; 赵恺; 刘若愚; 许百男; 孙国臣

doi:10.3969/j.issn.2095-5227.2021.01.005

内镜下经小骨窗清除亚急性创伤性硬膜下血肿疗效分析

Key-hole endoscopic surgery for treatment of traumatic subacute subdural hematoma evacuation

摘要

摘要:
背景硬膜下血肿是发生率最高的一类颅内血肿。其中亚急性硬膜下血肿尚无明确治疗标准。这类血肿特殊的病理生理学特点，为内镜下经小骨窗清除血肿提供了可能。
目的探讨内镜下经小骨窗清除亚急性硬膜下血肿的有效性。
方法选取解放军总医院第一医学中心2015年2月- 2019年6月11例需要手术的外伤性额颞顶叶亚急性硬膜下血肿患者。采取内镜下经小骨窗方式清除血肿(顶结节后方形成一个直径3 ~ 3.5 cm小骨窗)。分析血肿清除率、再出血率、手术时间、内镜工作时间和术中失血量等指标。
结果 11例患者平均年龄(50.7±18.4)岁，其中男性6例，女性5例。术前平均血肿体积为(101.02 ± 45.14) mL，术后第2天的CT扫描示无残留血肿，平均血肿清除率100%。颅脑CT提示术前平均中线移位为(11.45±3.66) mm，术后第1天显著改善至(5.15±1.92) mm (P＜0.01)，术后1个月中线正常。患者均无术后再出血。切皮到完成缝合的中位时间约35 min；内镜手术时间为20 min；总失血量＜50 mL。术前格拉斯哥昏迷量表平均得分为13.18±2.18；术后第1天改善为15±0(P=0.02)。
结论本组内镜下经小骨窗清除亚急性硬膜下血肿取得满意疗效。相较于常规开颅手术，此方法手术时间更短、手术创伤更小、出血量更少。

Abstract:
Background Subdural hematoma is the most common type of intracranial hematoma. However, there is no standard treatment for subacute subdural hematoma. Due to its special pathophysiological characteristics, it has potentials to be treated by key-hole endoscopic surgery .
Objective To investigate the effect of key-hole endoscopic surgery for subacute subdural hematoma evacuation in emergency situation.
Methods From February 2015 to June 2019, 11 patients with subacute subdural hematoma requiring surgery in the First Medical Center and Hainan Hospital of Chinese PLA General Hospital were enrolled in the study. Endoscopic hematoma evacuation was performed through a small bone window posterior to the parietal protuberance with the diameter of 3.0 - 3.5 cm. Hematoma clearance rate, re-bleeding rate, operating time, time of endoscopic procedure and intraoperative blood loss were recorded and analyzed.
Results Of the 11 cases of hematoma,10 were on the left side and one was on the right side. There were 6 males and 5 females, with average age of (50.7±18.4) years. The computed tomography analysis revealed that the mean preoperative hematoma volume was (101.02±45.14) mL before surgery, and there was no residual hematoma at day 2 after surgery, representing an average evacuation rate of 100%. The mean preoperative mid-line displacement was (11.45±3.66) mm, and the mid-line displacement reduced to less than (5.15±1.92) mm at 1 day after surgery (P＜0.01). At 1 month after operation, the midline returned to normal. No patient had postoperative re-bleeding. The median time from the incision to the wound close was less than 35 min (range: 30 - 50 min), the median time of endoscopic procedure was 20 min (range: 15 - 30 min), and total blood loss was less than 50 ml. The preoperative Glasgow Coma Scale score was 13.18±2.18, and it improved to 15.00±0 at day 1 after operation (P=0.020).
Conclusion Patients in this group has achieved satisfactory results by removing subacute subdural hematoma with key-hole endoscopic surgery, with shorter operating time and less surgical invasion and bleeding.

HTML全文

参考文献(21)

施引文献

资源附件(0)