摘要目的:探讨神经内镜锁孔开颅治疗急性外伤性硬膜下血肿的有效性和安全性。方法:回顾性分析2016年1月至2022年1月福建省立医院南院神经外科手术治疗的40例急性外伤性硬膜下血肿患者的临床资料。其中20例采用神经内镜锁孔开颅血肿清除术(微创组)，20例采用传统大骨瓣开颅手术治疗(传统组)。两组患者性别、年龄、术前硬膜下血肿量等基线资料的差异均无统计学意义(均 P>0.05)，具有可比性。分析比较两组患者的手术情况(包括手术时长及术中出血量等)、术后1 d格拉斯哥昏迷评分(GCS)、术后并发症及术后6个月格拉斯哥预后分级(GOS)。 结果:两组患者均顺利完成手术，微创组术中无一例扩大手术。与传统组比较，微创组的手术时长较短[分别为(73.8±6.7)min、(138.3±16.8)min， t＝15.92]、术中出血量较少[分别为(26.7±4.7)ml、(96.5±13.1)ml， t＝22.46]、术后血肿残余量较少[分别为(3.5±1.3)ml、(7.6±2.6)ml， t＝6.24]、住院时长较短[分别为(10.3±2.9)d、(13.8±3.2)d， t＝3.71]，差异均具有统计学意义(均 P<0.05)。与术前比较，微创组和传统组的术后1 d GCS均升高，差异均具有统计学意义(配对 t值分别为15.70、13.65，均 P<0.001)。两组比较，术后1 d GCS以及术后发生癫痫、肺部感染及颅内感染者占比的差异均无统计学意义(均 P>0.05)。术后6个月，所有患者的GOS均为Ⅴ级，两组比较差异无统计学意义( P＝1.000)。 结论:与传统大骨瓣开颅手术比较，采用神经内镜锁孔开颅手术治疗急性外伤性硬膜下血肿可缩短手术和住院时长，减少术中出血和血肿残留，而并发症发生比例和预后情况相近，是一种安全、有效、微创的方法。

abstractsObjective:To evaluate the effectiveness and safety of keyhole endoscopic surgery for acute traumatic subdural hematoma.Methods:The clinical data of 40 patients with acute traumatic subdural hematoma who were treated by neurosurgery in the Department of Neurosurgery, Fujian Provincial Hospital South Branch from January 2016 to January 2022 were retrospectively analyzed. Among them, 20 cases underwent neuroendoscopic keyhole hematoma removal (minimally invasive group) and 20 cases underwent conventional large bone flap craniotomy (conventional group). There was no statistically significant difference in baseline data such as gender, age, and preoperative subdural hematoma volume between the two groups of patients (all P>0.05), indicating comparability. We then analyzed and compared the surgical conditions (including operative duration and intraoperative bleeding volume), postoperative Glasgow Coma Scale (GCS) at 1 day, postoperative complications, and Glasgow Outcome Scale (GOS) at 6 months between the two groups of patients. Results:Both groups of patients successfully underwent the surgery, and there was no case of extended surgery in the minimally invasive group. Compared with the conventional group, the minimally invasive group had shorter surgical duration (73.8±6.7 min vs. 138.3±16.8 min, t=15.92), less intraoperative bleeding (26.7±4.7 ml vs. 96.5±13.1 ml, t=22.46), less residual hematoma after surgery (3.5±1.3 ml vs. 7.6±2.6 ml, t=6.24) and shorter hospital stay (10.3±2.9 d vs. 13.8±3.2 d, t=3.71). The differences were statistically significant (all P<0.05). Compared with the preoperative group, the postoperative GCS of the minimally invasive group and the conventional group increased 1 day, and the difference was statistically significant (paired t-value: 15.70 and 13.65 respectively, both P<0.001). There was no statistically significant difference between the two groups in the postoperative GCS at day 1, the incidence of epilepsy, pulmonary infection or intracranial infection (all P>0.05). At 6 months after surgery, all patients had the GOS of grade Ⅴ and there was no statistically significant difference between the two groups ( P=1.000). Conclusions:Compared with conventional large bone flap craniotomy, neuroendoscopic keyhole surgery for acute traumatic subdural hematoma could help shorten the surgical and hospitalization time, reduce intraoperative bleeding and residual hematoma, and is associated with comparable incidence of complications and prognosis. It is a safe, effective, and minimally invasive method.