神经损伤与功能重建2025，Vol.20Issue(8)：452-458,7.DOI:10.16780/j.cnki.sjssgncj.20250670
慢性硬膜下血肿不同微创手术临床疗效比较
Comparison of Clinical Efficacy Among Different Minimally Invasive Surgeries for Chronic Subdural Hematoma
摘要
Abstract
Objective:To analyze the clinical efficacy and prognosis of different minimally invasive surgical treatments for patients with chronic subdural hematoma(CSDH).Methods:A retrospective analysis was conducted on clinical data from 229 CSDH patients admitted to the Affiliated Hospital of Guizhou Medical University between January 2019 and December 2024.Based on treatment modalities,they were divided into two groups:the CT-guided group(n=122,receiving CT-guided minimally invasive intracranial hematoma puncture and drainage)and the burr hole group(n=107,including 45 cases undergoing neuroendoscope-assisted burr hole drainage and 62 cases receiving simple burr hole drainage).Baseline characteristics,laboratory parameters,surgical details,preoperative/postoperative imaging findings at 48 hours,and prognostic indicators were compared between groups.Risk factors for postoperative rebleeding were also analyzed.Results:Patients in the CT-guided group exhibited higher proportions of preoperative head CT midline shift>10 mm,intraoperative irrigation rates,intraoperative urokinase utilization,and lower Glasgow Coma Scale scores(<15 points upon admission)compared to the burr hole group(all P<0.05 or P<0.01).Conversely,this group demonstrated significantly shorter surgical duration,reduced intraoperative blood loss,fewer postoperative complications(intracranial air accumulation/fluid collection),and shorter hospital stays(all P<0.05 or P<0.01).Postoperative rebleeding occurred in 46 cases(rebleeding group)versus 183 cases without rebleeding(non-rebleeding group).Univariate analysis identified prior hypertension history and alcohol consumption as risk factors for postoperative rebleeding in CSDH patients.Conclusion:The CT-guided minimally invasive technique offers advantages including increased drainage catheter placement,thorough hematoma cavity irrigation with urokinase,resulting in shorter surgery and hospitalization times,reduced intraoperative bleeding,and lower complication rates.However,no statistically significant difference in long-term outcomes was observed between the two approaches.History of hypertension and alcohol use were identified as independent risk factors for postoperative rebleeding in CSDH patients.关键词
慢性硬膜下血肿/CT引导下微创颅内血肿穿刺引流术/单纯钻孔引流术/神经内镜辅助下钻孔引流术/临床疗效Key words
chronic subdural hematoma/CT-guided minimally invasive intracranial hematoma puncture and drainage/simple drilling and drainage surgery/drilling and drainage surgery assisted by neuroendoscopy/clinical efficacy分类
医药卫生引用本文复制引用
杨娴,任思颖,王丽琨,伍国锋..慢性硬膜下血肿不同微创手术临床疗效比较[J].神经损伤与功能重建,2025,20(8):452-458,7.基金项目
国家自然科学基金项目(激活PPARγ通过调控MTF1/CTR1通路抑制脑出血后神经元细胞铜死亡促进神经元突起再生修复的机制研究,No.82360253) （激活PPARγ通过调控MTF1/CTR1通路抑制脑出血后神经元细胞铜死亡促进神经元突起再生修复的机制研究,No.82360253）
贵州医科大学附属医院2024年国家自然科学基金培育计划(激活PPARγ/RXR调控线粒体稳态恢复反应性星形胶质细胞对神经元的线粒体转移促进脑出血后轴突再生修复的机制研究,No.gyfynsfc[2024]-04) （激活PPARγ/RXR调控线粒体稳态恢复反应性星形胶质细胞对神经元的线粒体转移促进脑出血后轴突再生修复的机制研究,No.gyfynsfc[2024]-04）
