摘要：

目的: 对比分析神经内镜硬膜下血肿清除术与钻孔引流术联合尿激酶治疗分隔型慢性硬膜下血肿的疗效。方法: 纳入2022年1月至2023年12月中国医学科学院北京协和医院收治的38例分隔型慢性硬膜下血肿患者，分别予以神经内镜硬膜下血肿清除术（内镜组，19例）和钻孔引流术联合尿激酶治疗（钻孔组，19例），计算血肿腔厚度变化率，采用改良Rankin量表（mRS）和Barthel指数（BI）评估神经功能预后和日常生活活动能力，记录术后引流时间、术后住院时间、总住院费用和脑脊液漏发生率。结果: 内镜组与钻孔组血肿腔厚度变化率差异无统计学意义（t = 0.858，P = 0.396）。内镜组和钻孔组出院时mRS评分低于入院时（Z = - 4.116，P = 0.000；Z = - 4.195，P = 0.000），BI指数较入院时无明显变化（Z = - 1.557，P = 0.119；Z = - 0.091，P = 0.928）；出院时两组mRS评分（Z = - 0.502，P = 0.616）和BI指数（Z =- 0.853，P = 0.394）差异均无统计学意义。内镜组术后引流时间长于钻孔组（t = 2.488，P = 0.018），但术后住院时间短于钻孔组（t = - 3.894，P = 0.000）；而两组总住院费用（t = 1.175，P = 0.248）和脑脊液漏发生率（Fisher确切概率法：P = 0.313）差异无统计学意义。结论: 分隔型慢性硬膜下血肿无论采取神经内镜硬膜下血肿清除术还是钻孔引流术联合尿激酶治疗均安全、有效，可清除血肿，改善神经功能；神经内镜手术具有术后神经功能恢复更快、术后住院时间更短的优势。

关键词: 血肿, 硬膜下, 慢性, 神经内窥镜检查, 引流术, 尿激酶型纤溶酶原激活物, 神经外科手术

Abstract:

Objective: To investigate and compare the efficacy of endoscopic-assisted hematoma evacuation and burr hole hematoma drainage combined with urokinase in the treatment of septated chronic subdural hematoma (CSDH). Methods: A total of 38 patients with septated CSDH who were admitted in Peking Union Medical College Hospital and received endoscopic-assisted hematoma evacuation (endoscopy group, n = 19) or burr hole drainage combined with urokinase (burr hole group, n = 19) from January 2022 to December 2023. The change rate of the hematoma cavity was calculated, the modified Rankin Scale (mRS) and Barthel Index (BI) were used to evaluate neurological function prognosis and abilities of daily living. In addition, postoperative drainage time, postoperative hospitalization time, total hospitalization cost and incidence of cerebrospinal fluid leakage were recorded. Results: The two treatment modalities did not show differences in the change rate of the hematoma cavity (t = 0.858, P = 0.396). Both endoscopy group (Z =-4.116, P = 0.000) and burr hole group (Z =-4.195, P = 0.000) had lower mRS scores on discharge than on admission, while the difference between the 2 groups on discharge was not significant (Z =-0.502, P = 0.616). The endoscopy group (Z =-1.557, P = 0.119) and burr hole group (Z =-0.091, P = 0.928) had no significant difference in BI scores on discharge versus on admission, and the difference in BI scores between the 2 groups on discharge was also not statistically significant (Z =-0.853, P = 0.394). Postoperative drainage time was longer in the endoscopy group (t =-2.488, P = 0.018), but postoperative hospitalization time was longer in the burr hole group (t =-3.894, P = 0.000). Total hospitalization cost in both 2 groups (t = 1.175, P = 0.248) and the incidence of cerebrospinal fluid leakage (Fisher's exact probability: P = 0.313) were not statistically significant. Conclusions: Both neuroendoscopic surgery and burr hole drainage combined with urokinase treatment are safe and effective in treating septated CSDH. They can clear the hematoma and improve neurological function; neuroendoscopic surgery can faster improve the neurological function and shorter postoperative hospitalization time.

Key words: Hematoma, subdural, chronic, Neuroendoscopy, Drainage, Urokinase-type plasminogen activator, Neurosurgical procedures