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%CI1.202～10.911, P=0.02）、年龄在65岁及以下（OR1.65, 95%CI1.051～2.602, P=0.03）和单侧硬膜下血肿（OR1.61, 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。
Objective To observe the safety, efficacy and clinical value of intra - neuroendoscopic technique （INET） in the treatment of subacute - chronic and chronic septal subdural hematoma. Methods A total of 74 patients who met the inclusion criteria during the period from May 2015 to April 2018 were enrolled in the study. The patients were divided into two groups according to the wishes of patients or their families： 35 cases in INET group and 39 cases in the control group. Baseline indicators and intraoperative and perioperative indicators were recorded and compared between the two groups. Patients＇ Bender grade at 1 month and hematoma recurrence rate at 6 months postoperation were recorded and followed - up. Multi - parameter Logistic regression model was used to analyze the risk factors associated with recurrence after 6 months of follow - up. Results The operation time [ （64.4 ± 13.6） min vs. （44.1 ±10. 8） min, P =0.00] was higher in the INET group than that in the control group, but the hematoma recurrence rate （2.9% vs. 23.0%, P =0.04） in the 6 months followup and subdural drainage tube placement time [ （2.1 ± 0.7） d vs. （3.9 ± 0. 8） d, P = 0.00 ] were significantly lower and shorter. There was no significant difference in intracranial infection rate （0.0% vs. 5.1%, P = 0.52）. The overall efficiency of Bender rating （100% vs. 89.7%, P = 0.15）in followup 1 month was not significant, but the rate of patient recovered to Bender 0 in INET group was significantly higher （94.2% vs. 76.9%, P = 0.04） than that in the control group. Multivariable Logistic regression identified that INET applied （OR 3.62, 95%CI 1.202 ±10.911, P=0.02）, age under 65 years （OR 1.65, 95% CI 1.051 ± 2.602, P = 0.03 ） and unilateral subdural hematoma （ OR 1.61, 95 % CI 1. 067 ± 2.418, P = 0.02） was associated with lower recurrence. Conclusion INET can reduce the postoperative recurrence rate of subacute - chronic and chronic septal subdural hematoma and improve clinical prognosis. It is a safe and effective new surgical method to treat these diseases.
作者
杜波
单爱军
李超
彭玉平
钟贤良
王进
张玉娟
Du Bo;Shan Ai-jun;Li Chao;Peng Yu-ping;Zhong Xian-liang;Wang Jin;Zhang Yu-juan(Department of Emergency,the Second Clinical College of Jinan University（Shenzhen People＇s Hospital）,Shenzhen 518020,China)
出处
《中国急救医学》
CAS
CSCD
北大核心
2018年第8期654-659,I0003,共7页
Chinese Journal of Critical Care Medicine
基金
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）
