目的 探讨神经内镜血肿清除术与脑膜中动脉栓塞治疗慢性硬膜下血肿的临床疗效及安全性。方法 回顾性分析2020年1月至2024年12月我院收治的120例慢性硬膜下血肿患者的临床资料。根据手术方式分为A组（内镜组，n=60）和B组（栓塞组，n=60）。比较两组患者手术时间、失血量、住院时间、术后并发症（颅内积气、癫痫、急性出血、脑组织损伤、穿刺点血肿）及术后6个月复发率。 结果 两组患者均成功完成手术, B组在手术时间、失血量及住院时间上均显著优于A组（P<0.05）；术后并发症A组颅内积气10例（16.67%），癫痫发作2例（3.33%）；B组腹股沟区穿刺点血肿3例（5.00%），两组总体并发症发生率差异有统计学意义（P<0.05）；随访6个月，A组复发率为8例（13.33%），B组复发2例（3.33%），差异具有统计学意义（P<0.05）。 结论 神经内镜可抵近观察下快速清除血肿、处理分隔、电凝止血，实现即刻减压，但伴随开颅手术创伤及颅内积气等不足；MMA栓塞术微创，住院时间短，促进血肿自然吸收且并发症少、复发率低，临床应用前景巨大。
Abstract
Objective To evaluate the clinical efficacy and safety of neuroendoscopic hematoma evacuation versus middle meningeal artery (MMA) embolization in the treatment of chronic subdural hematoma (CSDH). Methods A retrospective analysis was conducted on the clinical data of 120 patients with chronic subdural hematoma admitted to our hospital between January 2020 to December 2024. According to the surgical approach, patients were allocated into Group A (Endoscopy group, n=60) and Group B (Embolization group, n=60). The operative time, estimated blood loss, hospitalization duration, postoperative complications (including pneumocephalus, epileptic seizures, acute hemorrhage, brain tissue injury and puncture site hematoma), and the 6-month recurrence rate were compared between the two groups. Results All procedures were successfully completed in both groups. Group B demonstrated statistically significant superiority over Group A in terms of operative time, estimated blood loss, and length of hospital stay (P<0.05). Regarding postoperative complications, Group A had 10 cases (16.67%) of pneumocephalus and 2 cases (3.33%) of epileptic seizures. Group B experienced 3 cases (5.00%) of puncture site hematoma in the groin area. There was statistically significant difference in overall complication rate between the two groups (P<0.05). During the 6-month follow-up period, the recurrence rate was 8 cases (13.33%) in Group A and 2 cases (3.33%) in Group B, with a statistically significant difference (P<0.05). Conclusions Neuroendoscopy enables rapid hematoma evacuation, septation management, and electrocoagulation under close visualization, achieving immediate decompression. However, it is associated with craniotomy-related trauma and postoperative pneumocephalus. In contrast, MMA embolization is minimally invasive, associated with a short hospital stay, promotes spontaneous hematoma absorption, and offers fewer complications and a lower recurrence rate, demonstrating great potential for clinical application.
关键词
慢性硬膜下血肿； /
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神经内镜； /
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脑膜中动脉； /
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栓塞； /
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疗效分析； /
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复发率
Key words
Chronic subdural hematoma; /
Neuroendoscopy; /
Middle meningeal artery; /
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Embolization; /
Efficacy analysis; /
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Recurrence rate
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基金
国家自然科学基金资助项目（81502175）
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