目的：分析不同微创手术治疗慢性硬膜下血肿患者的临床疗效及预后。方法：回顾性分析贵州医科大 学附属医院2019年1月～2024年12月收治的229例慢性硬膜下血肿患者的临床资料，其中根据治疗方法分 为CT引导组（接受CT引导下微创颅内血肿穿刺引流术）122例和钻孔组（接受神经内镜辅助下钻孔引流术 45例、接受单纯钻孔引流术62例）107例。比较2组患者的基线资料、实验室指标、手术资料、术前及术后 48 h影像学资料、预后指标，并行术后再出血危险因素分析。结果：CT引导组患者术前头颅CT中线偏移＞ 10 mm、术中冲洗率、术中尿激酶使用率、入院格拉斯哥昏迷评分＜15分的患者比例高于钻孔组（均P＜0.05 或P＜0.01），手术时间、术中出血量、术后并发症（颅内积气、积液）、住院天数均低于钻孔组（均P＜0.05或 P＜0.01）。术后发生再出血46例（再出血组），未发生再出血183例（未再出血组）。术后再出血的单因素分 析中发现，既往高血压病史和饮酒史是慢性硬膜下血肿术后再出血的危险因素。结论：CT引导下微创颅内 血肿穿刺引流术通过增加引流管数量、术中联合尿激酶充分冲洗血肿腔等方式，在缩短手术时间和住院时 间、减少术中出血量和术后并发症方面优势显著，但2种术式预后差异无统计学意义；高血压病史和饮酒史 是慢性硬膜下血肿患者术后再出血的危险因素。

To analyze the clinical efficacy and prognosis of different minimally invasive surgical treatments for patients with chronic subdural hematoma (CSDH). Methods: A retrospective analysis was conducted on clinical data from 229 CSDH patients admitted to the Affiliated Hospital of Guizhou Medical University between January 2019 and December 2024. Based on treatment modalities, they were divided into two groups: the CT-guided group (n=122, receiving CT-guided minimally invasive intracranial hematoma puncture and drainage) and the burr hole group (n=107, including 45 cases undergoing neuroendoscope-assisted burr hole drainage and 62 cases receiving simple burr hole drainage). Baseline characteristics, laboratory parameters, surgical details, preoperative/postoperative imaging findings at 48 hours, and prognostic indicators were compared between groups. Risk factors for postoperative rebleeding were also analyzed. Results: Patients in the CT-guided group exhibited higher proportions of preoperative head CT midline shift >10 mm, intraoperative irrigation rates, intraoperative urokinase utilization, and lower Glasgow Coma Scale scores (<15 points upon admission) compared to the burr hole group (all P<0.05 or P<0.01). Conversely, this group demonstrated significantly shorter surgical duration, reduced intraoperative blood loss, fewer postoperative complications (intracranial air accumulation/fluid collection), and shorter hospital stays (all P<0.05 or P<0.01). Postoperative rebleeding occurred in 46 cases (rebleeding group) versus 183 cases without rebleeding (non-rebleeding group). Univariate analysis identified prior hypertension history and alcohol consumption as risk factors for postoperative rebleeding in CSDH patients. Conclusion: The CT-guided minimally invasive technique offers advantages including increased drainage catheter placement, thorough hematoma cavity irrigation with urokinase, resulting in shorter surgery and hospitalization times, reduced intraoperative bleeding, and lower complication rates. However, no statistically significant difference in long-term outcomes was observed between the two approaches. History of hypertension and alcohol use were identified as independent risk factors for postoperative rebleeding in CSDH patients.