慢性硬膜下血肿单纯钻孔引流疗效及复发因素分析  

作　　者：何斌 孙冬冬 孙远召 渠敬峰[2] 刘玲[2] 王彦 王轩 王大成 颜丙超 

机构地区：[1]新疆伊犁哈萨克自治州奎屯医院,833200 [2]江苏省徐州市第一人民医院,221000

出　　处：《浙江临床医学》2025年第1期62-63,共2页Zhejiang Clinical Medical Journal

摘　　要：目的分析单纯钻孔引流术治疗慢性硬膜下血肿的疗效及复发危险因素。方法回顾性分析2015年1月至2022年12月120例经单纯钻孔引流术治疗的慢性硬膜下血肿患者的临床资料,包括一般特征、影像学分型、治疗效果、并发症和影像学随访。采用Logistic回归分析慢性硬膜下血肿术后复发的危险因素。结果120例患者,男105例,女15例,年龄(68.83±13.45)岁。114例为单侧,6例为双侧。105例为均匀型,3例为分隔型,6例为片状型,6例为分层型。拔管前残留血肿厚度(11.12±13.45)mm。随访时间(3.3±2.6)个月,复发率为26.2%,均为影像学复发,均无症状。术后无感染、再出血、肺炎、伤口不愈合等并发症。Logistic回归分析发现术后拔管前最后1次CT残留血肿密度高为复发的独立危险因素(P=0.035,OR=4.980,95%CI:1.123~22.088)。结论慢性硬膜下血肿仅行单纯钻孔置管,术后尿激酶注入促进血肿排出的简单手术策略,是安全、有效的。术后拔管前的最后一次CT显示残留血肿高密度是复发的危险因素。Objective To analyze the efficacy and recurrence risk factors of simple drilling and drainage surgery in the treatment of chronic subdural hematoma.Methods Retrospectively analysed the clinical data of 120 patients with chronic subdural hematoma treated with simple drilling and drainage surgery from January 2015 to December 2022,including general characteristics,imaging subtyping,treatment efficacy,complications,and imaging follow-up.Use logistic regression analysis to identify risk factors for postoperative recurrence of chronic subdural hematoma.Results 120 patients,105 males and 15 females,aged(68.83±13.45)years.114 cases were unilateral,and 6 cases were bilateral.105 cases were of uniform type,3 cases were of separated type,6 cases were of patchy type,and 6 cases were of stratified type.The residual hematoma thickness before extubation was(11.12±13.45)mm.The follow-up time was(3.3±2.6)months,with a recurrence rate of 26.2%,all of which were imaging recurrences and asymptomatic.There were no postoperative complications such as infection,rebleeding,pneumonia,or non healing wounds.Logistic regression analysis found that the residual hematoma density on the last CT scan before extubation was an independent risk factor for recurrence(P=0.035,OR=4.980,95%CI:1.123~22.088).Conclusion The simple surgical strategy of simple borehole catheterization and postoperative injection of urokinase to promote hematoma evacuation is safe and effective for chronic subdural hematoma.The high-density residual hematoma displayed on the last CT scan before extubation after surgery is a risk factor for recurrence.

关 键 词：慢性硬膜下血肿 钻孔引流 尿激酶 复发 危险因素 

分 类 号：R651.15[医药卫生—外科学]