慢性硬膜下血肿术后复发的因素分析及微创治疗  

Analysis on the related factors of recurrence of chronic subdural hematoma after neurosurgery and minimally invasive treatment

作　　者：韩硕[1] 任力 黄焕斌 沙龙贵 韩东华 

机构地区：[1]上海交通大学医学院附属仁济医院神经外科,上海200127 [2]复旦大学附属浦东医院神经外科,上海201399

出　　处：《中国实用神经疾病杂志》2017年第21期37-40,共4页Chinese Journal of Practical Nervous Diseases

基　　金：上海市浦东医院课题(201403)

摘　　要：目的探讨影响慢性硬膜下血肿(chronic subdural hematoma,CSDH)术后复发的因素和诊疗方法。方法回顾近14a来经手术治疗的517例CSDH患者,并结合有关文献进行相关分析。结果术后复发16例,死亡3例,复发率和病死率分别为3.11%和0.58%。复发的16例患者平均年龄68.20岁。其中因服用抗凝剂复发5例,因术后大量颅内积气复发2例,CT高密度到混杂密度复发7例,CT等密度复发4例。结论凝血机制异常、术中冲洗出纤溶物质及纤维蛋白降解产物的程度、CT影像的密度为CSDH复发的影响因素。慢性硬膜下血肿术后复发应首选钻孔引流。Objective To explore the related factors and comprehensive treatment strategy and prognosis of recurrence of chrome subdural hematoma after neurosurgery. Methods The investigators summarized 517 eases with chronic subdural hematomas treated at our department from January 2003 to January 2017, and the factors were evaluated by the medical literature. Results 16 patients recurred after neurosurgery, and 3 patient died. Rate of recurrence and death were 3.11% and 0.58 % respectively. 16 patients with a mean age of 68.9.0 years recurred. Among these patients, 3 patients recurred due to anticoagulation therapy, 1 patient due to postoperative pneumocephalus, 1 patient＇s CT showed high density lesions, and 2 patients＇ CT showed equal and mixed density lesions. Conclusion Abnormal blood coagulation mechanism, intraoperative irrigation of fibrinolytic substances density, postoperative pneumocephalus, density in CT, drainage color and volume can affect the prognosis of recurrence of chronic subdural hematoma after neurosurgery.

关 键 词：慢性硬膜下血肿 复发 钻孔引流术 CT 影响因素 开颅清除术 

分 类 号：R651.15[医药卫生—外科学]