额部钻孔冲洗虹吸引流术治疗慢性硬膜下血肿(附139例报告)  

Treatment of irrigation through burr hole with siphonage drainage for chronic subdural hematoma: a report of 139 cases

作　　者：魏社鹏[1] 赵继宗[2] 周范民[3] 丁侃[1] 张巍峰[1] 张燕飞[1] 杨成[1] 魏亮[1] 张夔鸣[1] 孙志扬[1] 

机构地区：[1]同济大学东方医院神经外科,上海200120 [2]首都医科大学天坛医院神经外科,北京100050 [3]复旦大学华山医院神经外科,上海200040

出　　处：《解放军医学杂志》2011年第10期1077-1079,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨冲洗虹吸引流术治疗慢性硬膜下血肿的手术效果。方法回顾性分析2006年1月-2010年12月收治的139例慢性硬膜下血肿患者,其中男89例,女50例,年龄48～87岁,平均66.4岁。所有患者均经影像学确诊,依据手术方法不同分为3组,即顶部钻孔冲洗引流组(A组,n=47)、顶部钻孔冲洗抽吸引流组(B组,n=41)和额部钻孔冲洗虹吸引流组(C组,n=51)。术后行闭式引流,2～6d后拔管。在治疗前和治疗后第7天对所有患者进行日常生活能力(ADL)评定。术后随访12～36个月,观察治疗效果。结果 3组患者随访期间均无死亡发生。日常生活能力的改善(ADL评分)情况在C组明显优于B组和A组(P<0.05,P<0.01),且B组明显优于A组(P<0.05)。术后复发率在C组(0.02%)明显低于B组(12.19%,P<0.05)和A组(29.79%,P<0.01),且B组明显低于A组(P<0.05)。3组住院时间无明显差异(P>0.05)。结论额部钻孔虹吸冲洗引流术治疗慢性硬膜下血肿疗效确切,复发率低,并发症少,可适用于绝大部分患者。Objective To investigate the effect of irrigation through burr hole with siphonage drainage on chronic subdural hematoma（CSDH）.Methods The clinical data of 139 patients with CSDH（89 males and 50 females,aged from 48 to 87 with mean of 66.4 years） hospitalized from Jan.2006 to Dec.2010 were retrospectively reviewed.All the patients were finally diagnosed by radiology,and divided into 3 groups according to the operative method,i.e.parietal burr hole irrigation with drainage group（group A,n=47）,parietal burr hole irrigation and aspiration group（group B,n=41）,and frontal burr hole irrigation with siphonage drainage group（group C,n=51）.All the patients were treated with closed drainage for 2-6 days.The activity of daily living（ADL） scores was measured before and 7 days after operation in all patients.The patients were followed-up for 12-36 months to observe the treatment results.Results No death occurred in the 3 groups during the follow-up period.The improvement of ADL was markedly better in group C than in group B（P0.05） and group A（P0.01）,and in group B than in group A（P0.05）.The recurrence rate was significantly lower in group C（0.02%） than in group B（12.19%,P0.05） and group A（29.79%,P0.01）,and in group B than in group A（P0.05）.No significant difference was found regarding length of hospital stay among the 3 groups（P0.05）.Conclusion The frontal burr hole irrigation with siphonage drainage has a definite treatment effect for CSDH with a low recurrence rate and less complications,and is appropriate to use in most of CSDH patients.

关 键 词：血肿 硬膜下 慢性 神经外科手术 灌洗 引流术 

分 类 号：R651.155[医药卫生—外科学]