硬脑膜与血肿外膜不同切开方式在CSDH患者颅骨钻孔改良T管引流术中的效果对比  

Comparison of Effects of Different Incision Methods for Dura Mater and Hematoma Adventitia in Improved T-tube Drainage with Skull Drilling in patients with CSDH

作　　者：胡前信 何雨新 汪璟[1] HU Qianxin;HE Yuxin;WANG Jing(Wuxi Second People's Hospital,Wuxi 214000,China;不详)

机构地区：[1]无锡市第二人民医院(江南大学附属中心医院),江苏无锡214000

出　　处：《中外医学研究》2023年第34期123-127,共5页CHINESE AND FOREIGN MEDICAL RESEARCH

摘　　要：目的:对比硬脑膜与血肿外膜不同切开方式在慢性硬脑膜下血肿(CSDH)患者颅骨钻孔改良T管引流术中的效果。方法:将2020年1月—2023年1月无锡市第二人民医院收治的100例CSDH患者作为研究对象,按照硬脑膜与血肿外膜切开方式的不同将其分为一次切开组(n=50)和分层切开组(n=50)。一次切开组呈“+”形一次切开硬脑膜及血肿外膜,分层切开组呈“〇”形切除1 cm硬脑膜后,再电凝切开硬脑膜缘。比较两组术后相关指标、脑血流参数、并发症及短期预后情况。结果:分层切开组引流管留置时间、硬脑膜下积液量、非张力性气颅量优于一次切开组,差异有统计学意义(P<0.05);术后1周,两组大脑中动脉平均血流速度(Vm)、搏动指数(PI)较术前改善,差异有统计学意义(P<0.05),但两组比较,差异无统计学意义(P>0.05);分层切开组脑皮层损伤发生率低于一次切开组,差异有统计学意义(P<0.05),两组其他并发症发生率比较,差异无统计学意义(P>0.05);两组预后良好率、血肿复发率、再手术率比较,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或一次切开均能有效改善患者脑血流状态,且不影响预后恢复。但相较而言,分层切开更能有效降低术后硬脑膜下积液量和非张力性气颅量,缩短引流管留置时间,降低脑皮层损伤发生风险。Objective:To compare the effects of different incision methods of dura mater and hematoma adventitia in the improved T-tube drainage with skull drilling in patients with chronic subdural hematoma(CSDH).Method:A total of 100 patients with CSDH who admitted to Wuxi Second People's Hospital from January 2020 to January 2023 were selected as the research objects,they were divided into the one-time incision group(n=50)and the stratified incision group(n=50)according to the different incision methods of dura mater and hematoma adventitia.The dura mater and hematoma adventitia were cut in a"+"shape in the one-time incision group,and 1 cm dura mater was resected in a"○"shape,and then the dura mater edge was cut by electrocoagulationin the stratified incision group.The postoperative related indicators,cerebral blood flow parameters,complications and short-term prognosis of two groups were compared.Result:The drainage tube retention time,subdural fluid accumulation,and non tension pneumocranial volume in the stratified incision group were better than those in the one-time incision group,the differences were statistically significant(P<0.05);at 1 week after surgery,the average blood flow velocity(Vm)and pulsatile index(PI)of middle cerebral artery in two groups improved compared with those before surgery,the differences were statistically significant(P<0.05),but there were no statistically significant difference between two groups(P>0.05);the incidence of cortical injury in the stratified incision group was lower than that in the one-time incision group,the difference was statistically significant(P<0.05),while there were no statistically significant differences in other complications between two groups(P>0.05);there were no statistically significant differences in the good prognosis rate,hematoma recurrence rate and reoperation rate between two groups(P>0.05).Conclusion:For CSDH patients undergoing the improved T-tube drainage with skull drilling,the dura mater and hematoma adventitia stratified incision or one-time inci

关 键 词：硬脑膜 血肿外膜 分层切开 慢性硬脑膜下血肿 颅骨钻孔改良T管引流术 

分 类 号：R651.12[医药卫生—外科学]