钻孔引流术联合闭式冲洗操作方法对慢性硬膜下血肿并发症及疗效的影响  

Effect of Burr-hole Drainage Combined with Closed Irrigation on the Complications of Chronic Subdural Hematoma and the Clinical efficacy

作　　者：孙兵 匡永勤 马原 Sun Bing;Kuang Yongqin;Ma Yuan(Department of Neurosurgery, Western Theater General Hospital, Chengdu 610083, China)

机构地区：[1]西部战区总医院神经外科,成都610083

出　　处：《成都医学院学报》2020年第4期447-451,456,共6页Journal of Chengdu Medical College

基　　金：四川省科技厅重点研发项目(No:2017FZ0046)。

摘　　要：目的探讨钻孔引流术联合术中闭式冲洗操作方法对慢性硬膜下血肿(CSDH)术后并发症和疗效的影响。方法回顾性收集2017年1月至2018年9月西部战区总医院神经外科收治的98例单侧CSDH患者临床特点和影像资料,随机分为试验组(n=70)和对照组(n=28),两组患者术后均持续引流,术后1 d复查头颅CT,对术后硬膜下积气量、症状改善时间、残余血肿、颅内感染以及术后1年随访复发情况进行比较。结果试验组术后硬膜下积气量、剩余血肿量与对照组比较,差异有统计学意义(P<0.001),出院前患者症状改善时间优于对照组(P<0.001);两组颅内感染比较,差异无统计学意义(P=1.000);术后随访1年,试验组有1例复发,对照组有6例复发,其中4例需要再次手术,2例需开颅(P=0.002)。结论CSDH钻孔引流术联合闭式冲洗是一种比较安全的操作方法,降低了出血风险和术后气颅的形成,同时也降低了患者术后1年复发率和再手术率。Objective To explore the effect of burr-hole drainage combined with closed irregation during surgery on the complications of chronic subdural hematoma(CSDH)and the clinical efficacy.Methods The clinical features and imaging data of 98 patients with unilateral CSDH treated in Western Theater General Hospital from January of 2017 to September of 2018 were collected and analyzed retrospectively.The patients were randomly divided into the experiment group(n=70)and the control group(n=28).All the patients in both groups received continuous drainage after operation and they were reexamined with CT scan 1 day after operation.The postoperative subdural air accumulation,symptom improvement time,residual hematoma,intracranial infection and the recurrence during the 1-year follow-up were compared between the two groups.Results There were statistically significant differences between the experiment group and the control group in terms of subdural air accumulation and residual hematoma(P<0.001).The postoperative symptom improvement time in the experiment group was significantly shorter than that in the control group(P<0.001).There was no statistically difference between the two groups in terms of intracranial infection(P=1.000).During the 1-year follow-up,there were 1 case of recurrence in the experiment group and 6 cases of recurrence including 4 cases of reoperation and 2 cases of craniotomy in the control group,and the differences were statistically significant(P=0.002).Conclusion Burr-hole drainage combined with closed irrigation is a relatively safe operation method in the treatment of CSDH.It reduces the risk of bleeding and the postoperative formation of pneumocranium,and it also decreases the recurrence rate and reoperation rate of patients within one year after operation.

关 键 词：慢性硬膜下血肿 钻孔引流术 闭式冲洗 

分 类 号：R651.1[医药卫生—外科学]