钻孔引流术与神经内窥镜治疗慢性硬膜下血肿的对照研究

目的对常规钻孔引流术与神经内窥镜手术治疗慢性硬膜下血肿的临床疗效进行对比,探讨ICAM-1、VCAM-1的表达和意义。方法选择常规钻孔引流术治疗64例患者为常规组,选择神经内镜下手术治疗56例患者为内镜组,评价2组临床疗效、并发症发生率及复发率,用ELISA法检测2组外周静脉血、脑膜血和血肿腔血中ICAM-1及VCAM-1的水平。结果常规组总有效率低于内镜组(P0.05);内镜组并发症总发生率为53.57%,低于常规组并发症总发生率(P0.05);常规组复发率高于内镜组(P0.05),2组外周静脉血、硬脑膜血清中ICAM-1及VCAM-1的表达水平均低于血肿腔血(P0.05),且2组外周静脉血与硬脑膜血清中ICAM-1及VCAM-1的表达水平无显著差异(P0.05)。结论神经内镜下手术治疗CSDH较常规钻孔引流术可以更好改善临床疗效,减少并发症,降低复发率,值得临床广泛推广,此外,ICAM-1及VCAM-1可能与CSDH的发病密切相关,对研究CSDH的发病机制具有重要的意义。

Comparative study of conventional drilling drainage and neural endoscopic surgery on the chronic subdural hema-toma

Objective To compare the clinical efficacy of conventional drilling drainage with neural endoscopic surgery for the chronic subdural hematoma and the expression and significance of ICAM-1,VCAM-1.Methods We collected 64 patients trea-ted with normal drilling drainage treatment as normal group and 56 patients treated with neural endoscopic surgery treatment as endoscopy group.We evaluated the clinical efficacy,the incidence of complications and the recurrence rate of the two groups.We also assessed the ICAM-1 and VCAM-1 levels in peripheral venous blood,meninges and blood hematoma cavity blood of the two groups by using ELISA method.Results The total effective rate endoscopy group was significantly higher than that of normal group (P <0.05).Endoscopy group had a total incidence of complications of 53.57%,which was lower than normal group (P <0.05).The overall complication incidence and recurrence rate of endoscopy group were lower than those of normal group (P <0.05).Both groups had significantly higher expressions of ICAM-1 and VCAM-1 levels in peripheral venous blood and meninges than the hematoma cavity blood (P <0.05),and had similar expression of ICAM-1 and VCAM-1 levels in peripheral venous blood serum and dura mater (P >0.05).Conclusion Neural endoscopic surgery had a better clinical curative effect compared with the conventional drilling drainage in patients with CSDH.It can reduce the complications and recurrence rate and is worthy of promo-tion in the clinical work.In addition,ICAM-1,VCAM-1 may be closely related to the patients with CSDH and is of importance for the study of the pathogenesis of CSDH.