慢性硬膜下血肿钻孔引流术后复发的危险因素分析

Analysis of risk factors for recurrence after chronic subdural hematoma drilling and drainage surgery

目的探讨慢性硬膜下血肿(chronic subdural hematoma,CSDH)钻孔引流术后复发的危险因素。方法 2015年1月~2016年12月手术治疗的176例CSDH患者,其中复发患者12例。对比两组患者的年龄、血肿的影像学特征、服药情况,术后头颅CT表现等可能的危险因素;并结合有关文献进行分析。结果未复发患者的平均年龄(54.3±19.2)岁,复发患者的平均年龄(73.2±17.4)岁(P=0.01)。37例双侧血肿患者中复发4例(P=0.04)。服用抗凝药物27例患者中,复发4例(P=0.03)。39例术前CT示血肿密度不均一患者中复发9例(P=0.01);术后CT复查脑复张不全患者27例中,有7例复发(P=0.02);15例大量颅内积气患者中复发3例(P=0.04)。117例术中引流管置于血肿腔前部患者中复发5例,49例引流管留置于血肿腔后部患者中复发7例(P=0.008)。结论高龄、双侧血肿、服用抗凝药物、血肿密度不均一、引流管留置于血肿腔后部、术后颅内积气和脑复张欠佳是CSDH患者钻孔引流术后复发的危险因素。

Objective To investigate the risk factors for recurrence after chronic subdural hematoma（ CSDH）drillingand drainage surgery. Methods A retrospective review was conducted in 176 patients with CSDH operated with drilling and drainage surgery between January,2015 and December,2016. Recurrence was observed in 12 patients. The difference between the two groups in age,imaging characteristics of the hematoma,medications,postoperative CT performance and other possible risk factors were analyzed with review of previous releated literatures.Results The average age of patients without recurrence was（ 54. 3±19. 2） years old,recurrence patients＇ average age was（ 73. 2±17. 4） years old（ P = 0. 01）. Of 37 cases,4 relapsed in with bilateral hematoma（ P = 0. 04）. Of 27 patients who took anticoagulant drugs,there were 4 of recurrence（ P = 0. 03）. Among the 39 cases of preoperative CT showed hematoma uneven density,9 relapsed（ P = 0. 01）. There were 7 of recurrent in 27 patients with postoperative CT showed insufficient brain re-expansion（ P = 0. 02）,3 of 15 patients with the subdural severe pneumocephalus relapsed（ P = 0. 04）. Of 117 cases,the drainage tube was placed in the anterior segment of the hematoma,and 5 were relapsed. 49 of drainage tube were left in the posterior of the hematoma,7 were recurrence（ P = 0. 008）. Conclusion The risk factors of recurrence after drilling drainage surgery in CSDH patients are advanced age,bilateral hematoma,taking anticoagulant drugs,inhomogeneity of hematoma,drainage tube were left in the posterior of the hematoma,postoperative severe pneumocephalus and poor brain re-expansion.