两种手术方法治疗慢性硬膜下血肿伴急性出血的效果分析  

Clinical effect of two surgical methods in treatment of chronic subdural hematoma with acute hemorrhage

作　　者：何永跃 刘洛同 董程远 李祥龙 韩吉中 刘亮 陈礼刚 HE Yong-Yue;LIU Luo-Tong;DONG Cheng-Yuan;LI Xiang-Long;HAN Ji-Zhong;LIU Liang;CHEN Li-gang(Department of Neurosurgery, Affiliated Hospital of Southwest Medical University, Sichuan, Luzhou, 646000 Chin)

机构地区：[1]西南医科大学附属医院神经外科,四川泸州646000

出　　处：《国际神经病学神经外科学杂志》2018年第2期143-146,共4页Journal of International Neurology and Neurosurgery

摘　　要：目的分析采用开颅清除血肿与钻孔术腔冲洗持续引流治疗慢性硬膜下血肿伴急性出血的临床疗效。方法回顾性分析西南医科大学附属医院神经外科2008年5月至2017年8月收治的47例慢性硬膜下血肿伴急性出血患者的临床及随访资料,23例采用开颅清除血肿(开颅组),24例采用钻孔术腔冲洗持续引流(钻孔组)。比较两组术后置管时间、住院时间、术后1个月残余血肿量、3个月复发例数,并分析其临床效果。结果 3例患者失访,其中开颅组2例,钻孔组1例。开颅组置管时间1.9±0.7天,住院日10.8±1.3天,术后1月血肿残余2.0±0.5ml,复发0例。钻孔组置管时间5.5±0.9天,住院日11.2±1.2天,术后1月血肿残余13.4±1.8ml,复发3例;两组住院时间无统计学意义(P0.05),置管时间、术后1月血肿残余量、复发率有统计学意义(P<0.05)。结论对慢性硬膜下血肿伴急性出血患者,行开颅清除血肿较钻孔术腔冲洗持续引流具有置管时间短、术后1月血肿残余少、复发率低等优点。Objective To analyze the clinical effect of craniotomy versus burr-hole irrigation and drainage in the treatment of chronic subdural hematoma with acute hemorrhage. Methods A retrospective analysis was performed for the clinical and follow-up data of 47 cases of chronic subdural hematoma with acute hemorrhage admitted to Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, from May 2008 to August 2017. Twenty-three cases were treated with craniotomy to remove hematoma （eraniotomy group） ; 24 cases were treated with burr-hole irrigation and drainage （ drilling group）. The postoperative indwelling catheter time, length of hospital stay, residual hematoma volume at 1 month after operation, and the number of recurrences at 3 months were compared between the two groups, and the clinical efficacy was analyzed. Results Three cases were lost to follow-up, consisting of 2 cases in the craniotomy group and 1 case in the drilling group. In the craniotomy group, the indwelling catheter time was 1.9 ±0.7 days, the length of hospital stay was 10.8 ± 1.3 days, the residual hematoma volume was 2.0 ± 0.5 ml at 1 month after operation, and no recurrence was found. In the drilling group, the indwelling catheter time was 5.5 ± 0.9 days, the length of hospital stay was 11.2 ± 1.2 days, the residual hematoma volume was 13.4 ± 1.8 ml at 1 month after operation, and the number of recurrences was 3. There was no significant difference in the length of hospital stay between the two groups （P 〉 0.05 ） , while the indwelling catheter time, residual hematoma volume at 1 month after operation, and recurrence rate were significantly different between the two groups （P 〈 0.05 ）. Conclusions For patients with chronic subdural hematoma accompanied by acute hemorrhage, eraniotomy for hematoma removal is superior to burr-hole irrigation and drainage with shorter indwelling catheter time, less residual hematoma volume at 1 month after operation, and lower recurrence rate.

关 键 词：慢性硬膜下血肿 急性出血 开颅 钻孔术腔冲洗持续引流 

分 类 号：R651.1[医药卫生—外科学]