Craniocervical Manual Lymphatic Drainage Increases the Efficiency of Atorvastatin-Based Treatment of Chronic Subdural Hematoma
Craniocervical Manual Lymphatic Drainage Increases the Efficiency of Atorvastatin-Based Treatment of Chronic Subdural Hematoma
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DOI：
10.1007/s12975-022-01062-z
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发表时间：
2022-07-30
影响因子：
6.9
通讯作者：
Jiang, Rongcai
中科院分区：
文献类型：
--
作者：
Gao, Chuang;Wei, Yingsheng;Jiang, Rongcai
本研究的目的是探讨颅颈淋巴引流术（cMLD）是否能促进慢性硬膜下血肿（CSDH）患者的血肿吸收，并增加以阿托伐他汀为基础的保守治疗的有效率。回顾性筛选2020年10月至2022年2月期间在我科接受以阿托伐他汀为基础的治疗的所有CSDH患者入组。根据是否行cMLD分为对照组和cMLD组。两组患者均于治疗前、治疗后2周、4周行头颅CT或MR检查。在治疗前和治疗后约2周，在cMLD组中获得了23例患者的颈深淋巴结（dCLN）的MR图像。计算dCLN和血肿体积。主要结局是治疗4周后血肿体积减少的差异。次要结局为（1）两组患者第2周血肿体积减少的差异，（2）cMLD组治疗2周前后dCLN体积变化，以及（3）因保守治疗失败而转为手术的患者百分比。本研究共入组106例连续患者进行分析; 54例患者接受基于阿托伐他汀的治疗（对照组），52例患者接受基于阿托伐他汀的治疗和cMLD治疗（cMLD组）。基线时，对照组的平均血肿体积为76.53 ± 42.97 ml，cMLD组为88.57 ± 49.01 ml（p = 0.181）。在第4周，血肿减少的绝对数量（20.79 +/- 34.73 ml vs. 37.28 +/- 28.24 ml，p = 0.009）和血肿减少百分比cMLD组中的这些差异（22.58% +/- 60.01% vs. 46.43% +/-30.12%，p = 0.012）大于对照组。治疗2周后，两组的血肿减少绝对数量无差异，而cMLD组的血肿减少百分比更高（18.18% +/- 24.61% vs. 2.08% +/-25.72%，p = 0.001）。1例cMLD患者和8例对照组患者转为接受手术治疗。在cMLD组中，23名实验患者的dCLN体积在治疗2周后显著增加（p = 0.032）。没有需要报告的严重副作用。cMLD联合阿托伐他汀治疗可促进血肿吸收，降低手术率，为CSDH的治疗提供了新的策略。
The objective of this study is to explore whether craniocervical manual lymphatic drainage (cMLD) can promote hematoma absorption and increase the efficiency of atorvastatin-based conservative treatment in chronic subdural hematoma (CSDH) patients. All CSDH patients treated with atorvastatin-based therapy between October 2020 and February 2022 in our department were retrospectively screened for enrollment. The patients were divided into the control and cMLD groups according to whether cMLD was performed. Head CT or MR images in both groups were obtained before the treatment and 2 weeks and 4 weeks after the treatment. MR images of the deep cervical lymphatic nodes (dCLNs) in 23 patients were obtained in the cMLD group before and approximately 2 weeks after treatment. The volumes of the dCLNs and hematoma were calculated. The primary outcomes are the differences in hematoma volume reduction after 4 weeks of treatment. The secondary outcomes were (1) the differences in hematoma volume reduction between the patients in these two groups in the 2nd week, (2) the dCLN volume change in the cMLD group before and after 2 weeks of treatment, and (3) the percentage of patients who transitioned to surgery because of failure to the conservative treatment. A total of 106 consecutive patients were enrolled in this study for analysis; 54 patients received atorvastatin-based treatment (control group), and 52 were treated with both atorvastatin-based treatment and cMLD (cMLD group). At baseline, the mean hematoma volume was 76.53 +/- 42.97 ml in the control group and 88.57 +/- 49.01 ml in the cMLD group (p = 0.181). In the 4th week, the absolute number of hematoma reductions (20.79 +/- 34.73 ml vs. 37.28 +/- 28.24 ml, p = 0.009) and percentage of hematoma reductions (22.58% +/- 60.01% vs. 46.43% +/- 30.12%, p = 0.012) in the cMLD group were greater than those in the control group. After 2 weeks of treatment, the absolute number of hematoma reductions showed no difference in the two groups, while the percentage of hematoma reduction was higher in the cMLD group (18.18% +/- 24.61% vs. 2.08% +/- 25.72%, p = 0.001). One patient in cMLD and 8 patients in the control group were transitioned to receive surgical treatment. The dCLN volumes in 23 experimental patients increased significantly after 2 weeks of treatment in the cMLD group (p = 0.032). There were no severe side effects that needed to be reported. Combined with atorvastatin-based therapy, cMLD can promote hematoma absorption and decrease the surgery rate, which provides a new therapeutic strategy for CSDH.