经皮锥颅置管引流术治疗慢性硬膜下血肿的效果分析  

Efficacy of percutaneous bur hole drainage in the treatment of chronic subdural hematoma

作　　者：刘萃蕊 王华卿 Liu Cuirui;Wang Huaqing(Department of Neurosurgical Intensive Care Unit,Qilu Hospital of Shandong University,Jinan 250012,China)

机构地区：[1]山东大学齐鲁医院神经外科重症监护室,济南250012

出　　处：《中国临床实用医学》2022年第5期41-44,共4页China Clinical Practical Medicine

摘　　要：目的探讨经皮锥颅置管引流术治疗慢性硬膜下血肿(CSDH)的效果。方法本研究为回顾性研究, 选取2015年9月至2021年9月山东大学齐鲁医院急诊神经外科收治的134例单侧CSDH患者, 男99例, 女35例, 年龄(66.3±6.3)岁, 年龄范围为21~86岁。根据治疗方法不同, 将其分为穿刺引流组(n=95)与钻孔引流组(n=39), 穿刺引流组行经皮锥颅置管引流术, 钻孔引流组行头皮切口颅骨钻孔硬膜切开置管引流术。比较两组患者的术中情况(穿刺引流情况及手术时间)、术后情况(术后蛛网膜破裂导致脑脊液流出率、颅内积气率、尿激酶使用率、引流管保管时间及拔除引流管时残余硬膜下积液或血肿量)及随访情况(硬膜下脓肿发生情况、硬膜下血肿复发率及血肿完全消失情况)。结果穿刺引流组手术时间[(16.4±5.8)min]短于钻孔引流组[(43.5±6.4)min]、术后蛛网膜破裂导致脑脊液流出率[11.6%(11/95)]低于钻孔引流组[69.2%(27/39)]、颅内积气率[2.1%(2/95)]低于钻孔引流组[64.1%(25/39)]、引流管保管时间[(50.6±11.4)h]短于钻孔引流组[(56.6±16.4)h]、拔除引流管时残余硬膜下积液或血肿量[(6.8±2.8)ml]少于钻孔引流组[(13.4±5.8)ml], 差异有统计学意义(P<0.05)。结论经皮锥颅置管引流术治疗CSDH, 具有手术时间短、创伤小、颅内积气及蛛网膜破裂发生率低等优点, 治疗效果良好, 但应预防术中硬脑膜剥离及EDH的发生。Objective To investigate the efficacy of percutaneous bur hole drainage in the treatment of chronic subdural hematoma(CSDH).Methods This study was a retrospective study,a total of 134 patients with unilateral CSDH in the Neurosurgical Intensive Care Unit department of the Qilu Hospital of Shandong University from September 2015 to September 2021,including 99 males and 35 females,aged(66.3±6.3)years old,ranging from 21 to 86 years old.According to the different treatment methods,the patients were divided into puncture drainage group(n=95)and drilling drainage group(n=39),the patients in the puncture drainage group were treated with percutaneous puncture and drainage,the patients in the drilling drainage group were treated with skull trepanation and dura mater incision through scalp incision drainage.The intraoperative(puncture drainage and operation time),postoperative(the rate of cerebrospinal fluid outflow,the rate of intracranial gas accumulation,the use of urokinase,the time of keeping the drainage tube and the amount of residual subdural fluid or hematoma were caused by arachnoid rupture)and follow-up conditions(occurrence of subdural abscess,head injury recurrence rate and complete disappearance of hematoma)were compared between the two groups.Results The time of operation in the puncture drainage group[(16.4±5.8)min]was shorter than that in the drilling drainage group[(43.5±6.4)min],the rate of cerebrospinal fluid outflow caused by postoperative arachnoid rupture[11.6%(11/95)]was lower than that in the drilling drainage group[69.2%(27/39)],the rate of intracranial gas accumulation[2.1%(2/95)]was lower than that in the drilling drainage group[64.1%(25/39)],the time of keeping the drainage tube[(50.6±11.4)h]was shorter than that in the drilling drainage group[(56.6±16.4)h],and the amount of residual subdural fluid or hematoma[(6.8±2.8)ml]was less than that in drilling drainage group[(13.4±5.8)ml],the differences were statistically significant(P<0.05).Conclusions The treatment of CSDH by percutaneous tr

关 键 词：慢性硬膜下血肿 经皮锥颅置管引流术 微创 预后 并发症 

分 类 号：R651.15[医药卫生—外科学]