不同硬脑膜切开方式在慢性硬脑膜下血肿改良T管引流术中的效果对比  

Comparative study of different dural incision methods in modified T-tube drainage for chronic subdural hematoma

作　　者：孙峻峰[1] 郑维涛[1] 李康[1] 赵鑫[1] 康宁[1] 熊东胜 毛小林 高强[1] SUN Jun-feng;ZHENG Wei-tao;LI Kang;ZHAO Xin;KANG Ning;XIONG Dong-sheng;MAO Xiao-lin;GAO Qiang(Department of Neurosurgery,People’s Hospital of Baoji,Baoji Shaanxi 721000,China)

机构地区：[1]宝鸡市人民医院神经外科,陕西宝鸡721000

出　　处：《局解手术学杂志》2022年第4期337-341,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：陕西省宝鸡市卫生和计划生育局科研立项课题(2015-35)。

摘　　要：目的探讨在慢性硬脑膜下血肿(CSDH)患者行颅骨钻孔改良T管引流术治疗中不同硬脑膜切开方式的效果。方法选择72例行颅骨钻孔改良T管引流术的CSDH患者,按随机数字表法将其分为一次切开组(36例)和分层切开组(36例)。记录2组患者手术前后临床虚弱量表(CFS)评分、查尔森合并症指数(CCI)和格拉斯哥昏迷量表(GCS)评分;比较2组患者临床疗效及非张力性气颅量、硬脑膜下积液量、引流管留置时间、住院时间等临床指标;比较2组患者术后改良Rankin量表(mRS)评分预后不良率、出血率、感染率、慢性血肿复发率、再手术率。结果2组患者术前CFS、CCI评分比较差异无统计学意义(P>0.05);2组患者术后CFS评分降低、CCI评分升高,手术前后组内比较差异均有统计学意义(P<0.05),但术后组间比较差异无统计学意义(P>0.05)。2组患者GCS评分手术前后组内比较及组间比较差异均无统计学意义(P>0.05)。分层切开组术后好转率为100%,一次切开组术后好转率为97.22%,2组患者临床疗效比较差异无统计学意义(P>0.05)。分层切开组患者术后非张力性气颅量、硬脑膜下积液量少于一次切开组,分层切开组的引流管留置时间、住院时间短于一次切开组,组间比较差异均具有统计学意义(P<0.05)。2组患者术后mRS评分预后不良、出血、感染、慢性血肿复发、再手术的发生率比较,差异无统计学意义(P>0.05)。结论对于行颅骨钻孔改良T管引流术的CSDH患者,硬脑膜与血肿外膜分层切开可有效降低患者术后非张力性气颅量和硬脑膜下积液量,缩短引流管留置时间和住院时间,降低术后并发症发生率,与硬脑膜及血肿外膜一次切开比较,其治疗效果更好。Objective To explore the effects of different dural incision methods in the treatment of patients with chronic subdural hematoma(CSDH)undergoing cranial drilling and modified T-tube drainage.Methods A total of 72 patients with CSDH who underwent cranial drilling and modified T-tube drainage were selected,and they were divided into the single incision group(36 cases)and the stratified incision group(36 cases)according to the random number table method.The clinical frailty scale(CFS),Charlson comorbidity index(CCI)and Glasgow coma scale(GCS)of the two groups were recorded before and after surgery.The clinical efficacy and clinical indicators such as the amount of non-tension pneumocephalus,the amount of subdural fluid,retention time of the catheter,and length of hospital stay were compared between the two groups.The postoperative modified Rankin scale(mRS)score poor prognosis rate,bleeding rate,infection rate,chronic hematoma recurrence rate,and reoperation rate were compared between the two groups.Results There was no significant difference in the preoperative CFS and CCI scores between the two groups(P>0.05).After surgery,the CFS score decreased and CCI score increased in both groups,and the differences within the group before and after surgery were statistically significant(P<0.05),but there was no significant difference between the two groups after surgery(P>0.05).There was no statistically significant difference in the GCS scores between the two groups before and after operation(P>0.05).The postoperative improvement rate of the stratified incision group was 100%,and the postoperative improvement rate of the single incision group was 97.22%.There was no significant difference in the clinical efficacy between the two groups(P>0.05).The postoperative amount of non-tension pneumocephalus and subdural fluid in the stratified incision group were less than those in the single incision group,the retention time of the catheter and length of hospital stay in the stratified incision group were shorter than those in the s

关 键 词：慢性硬脑膜下血肿 分层切开 一次切开 组织膨胀复位 并发症 血肿复发 

分 类 号：R651.15[医药卫生—外科学]