慢性硬膜下血肿术后张力性硬膜下积液3例并文献复习  

Three cases of traumatic subdural effusion following surgery of chronic subdural hematoma and literature review

作　　者：胡玉鲲 张绪明 蔡家晨 金科 孙成法 Hu Yukun;Zhang Xuming;Cai Jiachen;Jin Ke;Sun Chengfa(Department of Neurosurgery,Affliated Changshu Hospital of Nantong University,Changshu,Jiangsu 215500,China;Department of Neurosurgery,Taicang Hospital of Traditional Chinese Medicine,Taicang,Jiangsu 215400,China)

机构地区：[1]南通大学附属常熟医院神经外科,江苏常熟215500 [2]太仓市中医院神经外科,江苏太仓215400

出　　处：《中国微侵袭神经外科杂志》2024年第5期284-289,共6页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：常熟市卫生健康委员会科技计划资助性项目(编号:csws202217)。

摘　　要：目的探讨慢性硬膜下血肿(chronic subdural hematom,CSDH)术后并发张力性硬膜下积液(traumatic subdural effusion,TSE)治疗对策。方法回顾性分析3例CSDH术后并发张力性TSE病例资料,包括一般信息、临床表现、影像学结果、治疗及预后。中文数据库(中国知网、维普、万方等)中检索2024年4月前CSDH术后并发张力性TSE的相关研究。结果3例CSDH患者术后均有头痛、意识下降,部分有恶心、呕吐等颅高压表现。经影像学检查证实发生张力性TSE,并可见中线不同程度偏移,切口愈合不良,拆线后切口可见高压液体喷出。均经历2次以上手术引流仍无法治愈,最终采用腰大池持续引流,逐步治愈出院。检索中文文献,3例患者与本研究病例相似。结论张力性TSE是CSDH术后罕见并发症,应手术彻底开放血肿腔进行引流。如疗效不佳,术后行腰大池持续引流可有效改善预后。Objective To investigate the treatment strategies for traumatic subdural effusion(TSE)after chronic subdural hematoma(CSDH)surgery.Methods The data of 3 patients with TSE after CSDH were analyzed retrospectively,including general information,clinical manifestations,imaging results,treatment and prognosis.Chinese databases(CNKI,VIP,Wanfang,etc.)were searched for relevant studies on TSE after CSDH surgery before April 2024.Results All three patients with CSDH had headache,decreased consciousness,and some had intracranial hypertension manifestations such as nausea and vomiting.TSE was confirmed by imaging examination,and varying degrees of midline deviation were seen,poor incision healing,and high-pressure liquid ejection could be seen from the incision after suture removal.After more than 2 times of surgical drainage,they could not be cured,and finally the lumbar cisterna was used for continuous drainage,and they were gradually cured and discharged.The Chinese literature was searched,and 3 patients were similar to the cases in this study.Conclusions TSE is a rare complication after CSDH,and the hematoma cavity should be completely opened for drainage.If the response is not satisfactory,continuous drainage of the lumbar cisterna after surgery can effectively improve the prognosis.

关 键 词：血肿 硬膜下 慢性 硬膜下积液 张力性 腰大池引流 

分 类 号：R651.15[医药卫生—外科学]