【摘要】 目的 探讨神经内镜下血肿清除术联合阿托伐他汀治疗复杂慢性硬膜下血肿(CSDH)的临床疗效与安全性。方法 回顾性分析2020年1月至2023年12月宜春市人民医院收治的71例复杂CSDH患者的临床资料，根据手术方式分为内镜组(n=36，行神经内镜下血肿清除术)和钻孔组(n=35，行常规钻孔引流术)，两组术后均口服阿托伐他汀钙片。比较两组患者的手术时间、术后残余血肿量、尿激酶使用率、引流管留置时间、术后1个月硬膜下积液发生率、术后住院时长、出院1个月改良Rankin量表(mRS)评分及血肿复发率。结果 与钻孔组相比，内镜组手术时间显著延长[(81.7±26.8)min vs.(50.6±15.7)min,P<0.001]，但术后残余血肿量更少[(12.2±8.1)mL vs.(20.1±16.4)mL,P=0.013]，尿激酶使用率更低(5.6%vs. 28.6%,P=0.010)，引流管留置时间更短[(2.0±0.5)d vs.(2.5±0.9 d),P=0.004]，术后1个月硬膜下积液发生率更低(38.9%vs. 60.0%,P=0.040)。两组术后住院时间、出院1个月mRS评分、血肿复发率差异均无统计学意义(P>0.05)。结论 神经内镜手术联合阿托伐他汀治疗复杂CSDH，虽手术时间较长，但能更有效地清除血肿，减少术后残余血肿量，降低尿激酶使用率及术后硬膜下积液发生风险，缩短引流管留置时间。该术式在处理机化血肿及血肿内分隔方面具有优势，且未增加术后并发症，是一种安全、有效的治疗选择。更多还原

【Abstract】 Objective To investigate the clinical efficacy and safety of neuroendoscopic hematoma removal combined with atorvastatin in the treatment of complex chronic subdural hematoma(CSDH).Methods A retrospective analysis was conducted on the clinical data of 71 patients with complex CSDH admitted to Yichun People’s Hospital from January 2020 to December 2023.According to the surgical method,patients were divided into an endoscopic group(n=36,undergoing neuroendoscopic hematoma removal) and a burr hole group(n=35,undergoing conventional burr hole drainage).Both groups received atorvastatin calcium tablets postoperatively.The surgical duration,postoperative residual hematoma volume,urokinase usage rate,drainage tube indwelling time,incidence of subdural effusion at 1 month postoperatively,postoperative hospital stay,modified Rankin Scale(mRS) score at 1 month after discharge,and hematoma recurrence rate were compared between the two groups.Results Compared with the burr hole group,the endoscopic group had a significantly longer surgical duration [(81.7± 26.8) min vs.(50.6 ± 15.7) min,P<0.001],but with less postoperative residual hematoma volume [(12.2 ± 8.1) mL vs.[(2.0±0.5) d vs.(2.5±0.9) d,P=0.004],and a lower incidence of subdural effusion at 1 month postoperatively(38.9% vs.60.0%,P=0.040).There were no statistically significant differences between the two groups in postoperative hospital stay,mRS score at 1 month after discharge,or hematoma recurrence rate(P>0.05).Conclusion Neuroendoscopic surgery combined with atorvastatin for complex CSDH,despite requiring a longer surgical duration,is more effective in hematoma clearance,reducing postoperative residual hematoma volume,lowering the urokinase usage rate and the risk of postoperative subdural effusion,and shortening the drainage tube indwelling time.This surgical approach offers advantages in managing organized hematomas and intrahematomal septations without increasing postoperative complications,making it a safe and effective treatment option.更多还原