目的 慢性硬膜下血肿（CSDH）临床常见、症状严重且治疗棘手。现有的手术方式无法同时解决清除血肿改善症状及预防血肿复发的难题，导致血肿复发率居高不下。本研究开发了新的手术治疗方法并验证其治疗效果。 方法 结合CSDH及硬脑膜中动脉的解剖特点，作者首次提出了神经内镜辅助下血肿清除并硬脑膜中动脉切断术（EHEMMA）。本研究结合病例描述了该手术方式，并通过回顾性队列对照分别收集EHEMMA术及神经内镜辅助血肿清除术（EHE）术的患者资料以及临床结局，比较两组患者的治疗效果。 结果 分别有32名及41名患者纳入EHEMMA及EHE组。术后180 d时，EHEMMA组患者血肿复发率显著低于EHE组(P=0.048)。EHEMMA组患者中无接受二次手术者，EHE组中6名患者接受二次手术。两组患者良好预后率、死亡率、术后颅内急性出血率及术区感染率均无显著差异。 结论 EHEMMA术安全性与EHE术相当，可以显著降低CSDH患者术后血肿复发率并减少二次手术的需求，并以更小的代价达到与EHE术相当的功能结局。
Abstract
Objective Chronic subdural hematoma (CSDH) is a prevalent and severe clinical condition that poses significant treatment challenges. The current surgical procedures are inadequate in addressing the removal and prevention of the hematoma, often resulting in high recurrence rates. This study developed a novel surgical procedure and validated its therapeutic effect. Methods Considering the anatomical features of CSDH and the middle dura mater artery, the author proposed a procedure known as Endoscopic Assisted Hematoma Evacuation and Mediated Meningeal Artery Angiogomy (EHEMMA). This retrospective study detailed the EHEMMA procedure and evaluated the conditions of patients and clinical outcomes, comparing them in the EHEMMA cohort with those of the cohort control undergoing Endoscopic Assisted Hematoma Evacuation (EHE). Results Thirty-two patients with CSDH were included in the EHEMMA group and 41 patients in the EHE group. Compared with the EHE group, the recurrence rate of hematoma was markedly reduced in the EHEMMA group (P=0.048), at 180 days following the surgeries. No patients in the EHEMMA group required additional surgery, while 6 patients in the EHE group received secondary surgeries. There were no significant differences between the two cohorts in terms of favorable outcomes, mortality, postoperative acute intracranial hemorrhage, and surgical site infection. Conclusions The EHEMMA procedure is deemed to be as safe as EHE and can significantly lower the risk of postoperative hematoma recurrence in CSDH patients. It also reduces the need for secondary surgeries, thus achieving comparable outcomes to EHE surgery in a cost-effective way.
关键词
慢性硬膜下血肿； /
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神经内镜； /
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血肿清除术； /
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硬脑膜中动脉
Key words
Chronic subdural hematoma; /
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Neuroendoscopy; /
Hematoma evacuation; /
Medial meningeal artery
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参考文献
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基金
国家自然科学基金资助面上项目(32271045)；空军军医大学临床研究项目(2023LC2322)
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