不同术式治疗慢性硬膜下血肿的疗效分析  

Analysis the therapeutic effects of different surgical treatments for chronic subdural hematoma

作　　者：伍葵[1] 徐善水[1] Wu Kui;Xu Shanshui.(Department of Neurosurgery , The First Affiliated Hospital of Wannan Medical College ,Wuhu , 241000, China)

机构地区：[1]皖南医学院附属弋矶山医院(第一附属医院)神经外科,芜湖241000

出　　处：《立体定向和功能性神经外科杂志》2018年第1期50-53,共4页Chinese Journal of Stereotactic and Functional Neurosurgery

摘　　要：目的探讨不同术式治疗慢性硬膜下血肿的疗效及对手术远期效果的影响,为临床手术治疗慢性硬膜下血肿提供一定参考。方法回顾性分析了107例进行"颅骨单钻孔引流术"治疗的慢性硬膜下血肿患者的临床及影像学资料。根据术中是否采用生理盐水彻底冲洗血肿腔将上述患者分为BHD组与BHDI组,收集两组患者术前一般资料,包括:患者性别、年龄、基础疾病情况、手术前血肿量、术后残余血量及术后颅内积气等,比较了两组上述资料间的差异情况。结果两组患者在性别、年龄、基础疾病、抗凝药物治疗等资料上的差异无明显统计学意义(P<0.05);BHD组患者术后血肿量残余要明显高于BHDI组(P<0.05),BHDI组患者术后存在明显颅内积气情况;两组患者术后MRS评分均明显改善,两组间比较未见明显差异(P=0.47);BHDI组患者术后复发率要略高于BHD组(P=0.03)。结论颅骨钻孔引流术治疗慢性硬膜下血肿术中未进行生理盐水冲洗血肿腔对手术效果无明显影响,且能减少术后颅内积气及复发率。因此,临床手术过程中可考虑术中不进行生理盐水彻底冲洗血肿腔的手术方式,术后配合口服阿托伐他汀钙片亦可达到良好的治疗效果。Objective To investigate the advantages and the impact on the long-term effect of burr-hole craniotomy to treat chronic subdural hematoma with different surgical procedures this irrigated or didn＇t irrigate the hematoma cavity thoroughly with saline.Methods Retrospectively analyzed clinical and imaging data of 107 patients with skull single bore-hole drainage treatment of chronic subdural hematoma.According to whether using saline thoroughly flushed hematoma cavity,the patients were divided into BHDI group（irrigation）and BHD group（no irrigation）.Two groups of patients＇ general information were collected,including：patients＇ gender,age,basic diseases,hematoma volume before surgery,postoperative residual volume and postoperative intracranial pneumatics,and then,compares the differences between the two groups of the above information.Enumeration data were compared with χ^2 test,with measurement data using two independent samples T test,by P〈0.05 to determine statistical significance.Results There was no statistically significant difference in the patients of sex,age,basic disease and anticoagulant therapy of the two groups（P〉0.05）.The residual hematoma volume of patients in the group of BHD was significantly higher than that in BHDI Group（P〈0.05）,and there were obvious postoperative intracranial pneumatics after operation in BHDI Group（P〈0.05）.MRS Score was significantly improved in both groups,but no significant difference was found between the two groups（P=0.47）,and the postoperative recurrence rate of BHDI group was slightly higher than that of the BHD group（P=0.03）.Conclusion The treatment of chronic subdural hematoma without saline flushing hematoma cavity by skull drilling drainage has no significant effect on the operation effect,and can reduce the postoperative intracranial gas and recurrence rate.Therefore,in the course of clinical operation,we can consider the operation method without normal saline flushing the hematoma cavity thoroughly,and the postoperative tre

关 键 词：慢性硬膜下血肿 颅骨单钻孔外引流术 术中冲洗 

分 类 号：R651.1[医药卫生—外科学]