快速细孔钻颅置管引流治疗慢性硬脑膜下血肿510例  

Rapid small hole cranio-puncture apparatus for treatment of chronic subdural hematoma drainage of 510 cases

作　　者：王成伟[1] 潘树茂[2] 汤苏文 李猛[4] 白云安 杜继海 王保安 孟庆虎[1] 李刚[8] 杨军[2] 张庆林[1] 

机构地区：[1]山东大学第二医院神经外科,济南250033 [2]山东滨州医学院烟台附属医院神经外科 [3]山东日照市中医院神经外科 [4]山东省千佛山医院神经外科 [5]山东益都中心医院神经外科 [6]山东莒县人民医院神经外科 [7]山东淄博市第一医院神经外科 [8]山东大学齐鲁医院神经外科

出　　处：《中华神经外科杂志》2014年第12期1244-1246,共3页Chinese Journal of Neurosurgery

基　　金：山东省科技发展计划（2008GG10002059）,山东大学“985工程Ⅲ期”神经外科建设项目.

摘　　要：目的 探讨快速细孔钻颅置管引流术治疗慢性硬脑膜下血肿（CSDH）的疗效,为CSDH的治疗提供临床经验.方法 回顾自1970年应用自主研发的快速细孔钻颅置管引流术治疗510例CSDH患者的临床资料,结合1例CSDH死亡患者尸体解剖资料进行相关讨论.全部病例经脑血管造影、颅脑CT或MRI确诊,血肿引流量60 ～ 340 ml,多为80 ～ 120 ml.快速细孔钻颅一般选择顶结节处或在血肿最厚部位为钻颅点,根据头皮及颅骨厚度确定钻头前段长度,穿刺成功后置管持续低位引流3～5d.手术应注意精确限制钻头前段长度、选择血肿最厚处穿刺、术后及时复查颅脑CT.结果 全部病例采用快速细孔钻颅置管引流手术,手术时间单侧3 ～5 min左右,双侧6-8 min.引流时间2～8d,多数病例引流3～5d.治愈433例（84.9％）,好转75例（14.9％）,死亡2例（0.4％）.手术穿刺致硬膜外血肿2例,引流管误插入脑室质内形成少量血肿1例.结论 快速细孔钻颅置管引流术是治疗CSDH安全、有效、简易、快捷的微创手术方式.Objective To explore the treatment effect of rapid small hole cranio-puncture apparatus for the chronic subdural hematoma （CSDH） drainage,and povide clinical experiences of CSDH treatment.Methods The clinical data of 510 patients of CSDH treated by rapid small hole cranio-puncture apparatus of self-development and autopsy data of one patient died of CSDH were retrospectively studied.All the cases were diagnosed with cerebral angiography,CT or MRI.The parietal tuber or the thickest site of hematoma was usually used as the puncture point,and the length of drill＆#39;s forepart was designed by the thickness of scalp and skulls.Continuous low position catheter drainage was adopted for 3 to 5 days after surgery.Accurate length restriction of the drill＆#39;s forepart,puncturing the thickest site of hematoma,and timely cerebral CT examination should be noticed.Results In all patients treated of rapid small hole cranio-puncture,the operating time was only 3 to 5 minutes with unilateral puncture,while bilateral puntcure needed 6 to 8 minutes.The hemorrhage drainage volume was among 60 to 340 ml,mostly 80 to 120 ml,and the drainage duration was among 2 to 8 days,mostly 3 to 5 days.433 patients （84.9%） patients were cured,75 patients got improvement （14.9%）,and 2 patient （0.4%） died.The complications included epidural hematoma （2 cases,0.4%） and little intracerebral hematoma induced by the drainage tube inserted into the brain parenchyma incautiously （1 case,0.2%）.Conclusions Drainage of CSDH via rapid small hole cranio-puncture apparatus was effective,safe,simple and fast.

关 键 词：细孔钻颅 引流术 血肿 硬膜下 慢性 

分 类 号：R651.15[医药卫生—外科学]