30例成人创伤性进展型硬膜下积液治疗体会  

Summary of the treatment for 30 cases of traumatic progressive subdural effusion in adults

作　　者：孙继程 赵刚[1] 李贵民[1] 王宇[1] 刘帅[1] 李俊[1] 张义[1] 高峰[1] 杨成国[1] 

机构地区：[1]铁法煤业(集团)总医院神经外一科,辽宁调兵山112700

出　　处：《中国现代医生》2017年第1期40-43,共4页China Modern Doctor

摘　　要：目的总结各种术式对成人创伤性进展型硬膜下积液的临床疗效。方法对2000年1月~2016年6月30例成人创伤性进展型硬膜下积液患者术式进行回顾性分析,根据其愈后总结手术疗效。结果术后患者随访3~6个月。18例22次行局部外引流术,仅2例积液减少。10例行局部外引流术加腰大池引流术,3例减少。14例行积液腹腔分流术,6例积液减少,7例积液消失,有效率为92.9%。8例行开颅积液包膜切除、蛛网膜下腔沟通术,4例积液减少,3例积液消失,有效率为87.5%。手术总有效率为83.3%。结论成人创伤性进展型硬膜下积液采用以手术为主的综合个体化治疗方案,应尽早预防,避免其发生。积液腹腔分流术及开颅积液包膜切除、蛛网膜下腔沟通术是较为可靠的手术方式,而单纯局部外引流术几乎无效,即使加腰大池引流术也疗效甚微。Objective To summarize the clinical effect of various surgical procedures on traumatic progressive subdural effusion in adults.Methods The surgical procedures of 30 adult patients with traumatic progressive subdural effusion from January 2000 to June 2016 were retrospectively analyzed,and the clinical effect of the surgery was summarized according to the prognosis.Results The patients were followed up for 3-6 months.18 cases were given local external drainage for 22 times,and only 2 cases showed fluid reduction.10 cases were given local external drainage combined with lumbar cistern drainage,and 3 cases showed fluid reduction.14 cases were given intraperitoneal shunt effusion,with 6 cases of reduced fluid,and 7 cases of disappeared fluid.The effective rate was 92.9%.8 cases were given craniotomy fluid capsule excision and subarachnoid shunt,with 4 cases of reduced fluid,and 3 cases of disappeared fluid.The effective rate was 87.5%.The total effective rate was 83.3%.Conclusion For the treatment of adult patients with traumatic progressive subdural effusion,a comprehensive individualized treatment protocol based on surgery is adopted,so that the disease can be prevented earlier and the occurrence can be avoided.Fluid peritoneal shunt,craniotomy fluid capsule excision and subarachnoid shunt are more reliable surgical approaches.The simple local external drainage is almost ineffective,and the curative effect is still not favorable even if it is combined with lumbar cistern drainage.

关 键 词：进展型硬膜下积液 脑积液腹腔分流术 开颅积液包膜切除 蛛网膜下腔沟通术 外引流术 腰大池引流术 

分 类 号：R743.33[医药卫生—神经病学与精神病学]