改良单孔引流术在慢性硬膜下血肿治疗中的应用  

Application of modified single-port drainage in the treatment of chronic subdural hematoma

作　　者：王亮[1] WANG Liang(Department of Neurosurgery,Chuzhou First People's Hospital,Chuzhou 233900,China)

机构地区：[1]安徽省滁州市第一人民医院神经外一科,安徽滁州233900

出　　处：《现代医学》2023年第7期928-934,共7页Modern Medical Journal

摘　　要：目的:分析“单孔单管引流”和改良后“单孔-双管冲洗、排气”+术后“单孔-单管引流”两种手术方式在慢性硬膜下血肿手术治疗中术后颅内积气的残余和吸收中的差异。方法:选取2016年9月1日—2022年10月31日我院(南区)收治的慢性硬膜下血肿且施行手术的患者为研究对象开展回顾性研究,按手术方式的不同分为实验组(55例)和对照组(66例)。术后均给予相同的护理措施、治疗方案进行治疗。对两组患者住院时的年龄、手术时间、入院时格拉斯哥昏迷量表(GCS)、住院天数、术后颅内积气量、拔管时颅内积气量、感染率、复发率进行统计分析。结果:我院慢性硬膜下血肿病人就诊人数近两年有减少的趋势。两组患者在年龄、手术时间、入院时GCS评分、住院天数、临床症状改善及治疗有效率、感染率的比较差异无统计学意义(P>0.05)。121份病例两种手术方式术后复查头颅CT均提示血肿清除率大于90%,所有患者术后症状均得到缓解(包括消失、明显缓解和缓解),且出院时GCS均能达到15分,两组总有效率均能达100%。在术后颅内积气量、拔管时颅内积气量和术后复发率的对比中,对照组中感染4例(6.1%),实验组中感染1例(1.8%)(P=0.244);对照组复发5人(7.6%),实验组无复发(P=0.045)。结论:在慢性硬膜下血肿的钻孔手术治疗中,两种手术方案均安全有效,其中改良的单孔单管冲洗引流术能更好地降低术后颅内积气量和拔管时的颅内积气量,从而降低术后复发率。Objective:To analyze the difference of residual and absorbed postoperative intracranial gas in the surgical treatment of chronic subdural haematoma between the“single-hole,single-tube drainage”and the modified“single-hole,double-tube flushing and venting”+postoperative“single-hole,single-tube drainage”surgical approach.The differences in the residual and absorption of postoperative intracranial gas in the surgical treatment of chronic subdural hematoma.Methods:Patients with chronic subdural haematoma who underwent surgery from September 1 in 2016 to October 31 in 2022 in our hospital(South Zone)were selected for the retrospective study,and divided into experimental group(55 cases)and matched group(66 cases)according to the different surgical methods.All patients were treated with the same care and treatment protocols after surgery.The age at the time of hospitalization,duration of surgery,GCS score at admission,duration of hospital stay,amount of postoperative intracranial pneumonia,amount of intracranial pneumonia at extubation,infection rate and recurrence rate of the patients in both groups were statistically analyzed.Results:The number of patients attending our hospital with chronic subdural haematoma has tended to decrease in the last two years.There was no statistically significant difference between the two groups in terms of age,time of surgery,Glasgow coma scale(GCS)score at admission,days in hospital,clinical symptom improvement and treatment efficiency,and infection rate(P>0.05).121 cases had a postoperative review of cranial CT in both surgical procedures indicating haematoma clearance rate more than 90%,all patients had postoperative symptom relief(including disappearance,significant relief and remission),and at discharge,the GCS score could reach 15 in all cases,and the overall efficiency rate could reach 100%in both groups.In comparison of postoperative intracranial gas volume,intracranial gas volume at extubation and postoperative recurrence rate,there were 4 cases of infection(6.1%)in

关 键 词：慢性硬膜下血肿 钻孔冲洗引流术 改良单孔冲洗引流术 颅内积气 

分 类 号：R651.11[医药卫生—外科学] R651.15[医药卫生—临床医学]