慢性硬膜下血肿患者钻孔置管引流失败后再次行神经内镜下血肿清除术的疗效分析  

Neuroendoscopic surgery for failure of burr hole craniotomy in patients with chronic subdural hematoma

作　　者：郑鹏锋 林章雅[2] 曾广明 魏德[1] Zheng Pengfeng;Lin Zhangya;Zeng Guangming;Wei De(Department of Neurosurgery, South Branch of Fujian Provincial Hospital, Fuzhou 350028, China;Department of Neurosurgery, First Affiliated Hospital of Fujian Medical University, Fuzhou 350000, China)

机构地区：[1]福建省立医院南院神经外科,福州350028 [2]福建医科大学附属第一医院神经外科,福州350000

出　　处：《中华神经医学杂志》2019年第9期910-913,共4页Chinese Journal of Neuromedicine

摘　　要：目的探讨慢性硬膜下血肿患者行钻孔置管引流术失败的原因以及再次行神经内镜下血肿清除术的补救优势。方法福建省立医院南院神经外科自2015年5月至2019年5月共收治慢性硬膜下血肿患者100例,首次手术均采用钻孔置管引流术治疗,其中15例患者钻孔置管引流失败后再次行神经内镜下血肿清除术,回顾性分析该15例患者的临床资料和疗效。结果首次术后1 d颅脑CT显示引流管位置错误6例,其中引流管置入脑组织2例,引流管位于血肿内膜下3例,引流管位于血肿包膜外1例;引流管位于血肿分隔腔内9例。15例患者首次手术的疗效均为无效,再次手术的疗效均为显效,术后6个月随访显示均无明显复发。2例患者因首次手术时置管伤及脑组织,遗留有一侧肢体乏力;余13例患者格拉斯哥预后量表(GOS)评分显示预后良好。结论钻孔置管引流术治疗硬膜下血肿时操作应规范,确认引流管位于血肿腔内,术中冲洗彻底;对于首次钻孔置管引流术失败患者,神经内镜下血肿清除术为一种有效的补救方案。Objective To investigate the reasons of failure of burr hole craniotomy with drainage in patients with chronic subdural hematoma (CSDH) and advantages of survived neuroendoscopic surgery. Methods One hundred patients with CSDH, admitted to our hospital from May 2015 to May 2019, were enrolled. All patients were initially treated by burr hole craniotomy with drainage;15 showed drainage failure and received survived neuroendoscopic hematoma evacuation. The preoperative and postoperative clinical features and treatment efficacy of these 15 patients were analyzed. Results Out of the 15 failed patients, 6 had drainage tube misplacement, and the other 9 showed drainage obstacle with separated hematoma. In 6 with drainage tube misplacement, 2 had drainage tube placed into the brain tissues, 3 had drainage tube located in the subendothelium of the hematoma, and one had drainage tube located outside the hematoma. Fifteen patients underwent neuroendoscopic hematoma resection, and the curative effect was significant. After 6 months of follow-up, the hematoma disappearance. Two patients were left with limb weakness due to catheter injury and brain tissues during the initial operation. Glasgow outcome scale indicated good prognosis in the remaining 13 patients. Conclusions Burr hole craniotomy should be standardized, and the drainage tube should be located in the hematoma cavity and thorough rinse should be performed. Neuroendoscopic hematoma evacuation is an effective remedy for failure of the first drilling and drainage surgery.

关 键 词：慢性硬膜下血肿 钻孔置管引流 神经内镜 血肿清除 

分 类 号：R651[医药卫生—外科学]