根据病灶CT密度值选择术式治疗慢性硬膜下血肿51例  

Treatment of 51 cases of chronic subdural hematoma according to the CT value of the lesion

作　　者：徐兵[1] 黄录茂[1] 雍成明[1] 杨代明[1] 邵雪非 XU Bing;HUANG Lumao;YONG Chengming;YANG Daiming;SHAO Xuefei(Chaohu Hospital of Anhui Medical University,Hefei 238000,China)

机构地区：[1]安徽医科大学附属巢湖医院,合肥238000

出　　处：《山东医药》2018年第11期69-71,共3页Shandong Medical Journal

基　　金：皖南医学院校级科学研究项目(WK2017ZF04);皖南医学院中青年科研基金

摘　　要：目的观察根据病灶CT密度值选择术式治疗慢性硬膜下血肿(CSDH)的效果。方法 100例CSDH老年患者根据手术方法不同分为观察组51例和对照组49例。观察组患者根据CT密度值选择术式,其中低密度患者(25例)采用单纯局麻下单孔单管冲洗血肿腔治疗;等密度和混杂密度患者(21例)采用局麻下单孔冲洗引流术,若存在分隔可进一步辅以神经内镜去除血肿分隔;高密度患者(5例)采用局麻下单孔双管或双孔持续冲洗治疗,针对冲洗引流不佳患者需进一步改用大脑开颅血肿清除术。对照组采用常规开颅钻孔引流术治疗。比较两组治疗效果。结果观察组治疗有效率、SF-36生活质量评分均高于对照组,而神经功能缺损评分和复发率均低于对照组,P均<0.05。治疗有效者CT密度值低于治疗无效者,未复发CT密度值低于复发者,P均<0.05。Logistics回归分析显示,CSDH患者CT密度值与疗效、预后复发有相关性。结论根据CT密度值选择术式治疗CSDH可有效提高疗效,降低术后复发率。Objective To observe the effect of selective surgical treatment of chronic subdural hematoma(CSDH)according to the CT density value of the lesions.Methods Totally 100 elderly patients with CSDH were divided into the observation group(51 cases)and control group(49 cases)according to the different surgical methods.The patients in the observation group were subdivided according to the CT density value.The hematoma cavity of low-density patients(25 cases)were flushed with single hole and single tube under simple local anesthesia.Density and mixed density patients(21 cases)accepted the single-hole drainage surgery under local anesthesia,if there were separated hematoma,we could use the neuroendoscopy to remove.High-density patients(5 cases)were treated with single-hole double-or double-hole continuous irrigation under local anesthesia.Patients with poor irrigation and drainage needed to be further switched to brain craniotomy.Patients in the control group were treated with conventional craniotomy and drainage.The therapeutic effects of the two groups were compared.Results The effective rate and SF-36 quality of life in the observation group were higher than those in the control group,while the neurological deficit score and recurrence rate were lower(all P<0.05).The CT density value of the effective treatment was lower than that of the ineffective treatment,and the CT density value in the non-recurrent patients was lower than that of the relapse ones(all P<0.05).Logistics regression analysis showed that the CT density of CSDH patients was correlated with the curative effect and the recurrence of prognosis.Conclusion Choosing surgical treatment of CSDH based on CT density value can effectively improve curative effect and reduce postoperative recurrence rate.

关 键 词：CT密度值 慢性硬膜下血肿 开颅钻孔引流术 

分 类 号：R722.14[医药卫生—儿科]