慢性硬膜下血肿术中引流管安置的临床研究

Clinical study of drainage catheter location during treatment of chronic subdural hematoma

目的探讨慢性硬膜下血肿(CSDH)钻孔引流术引流管头端安置的最佳位置,以降低血肿复发率。方法分析130例CSDH患者术前硬膜下血肿宽度、中线移位程度、术后引流管头端不同部位(额、颞、顶、枕)、术后硬膜下腔的宽度、硬膜下腔积气与术后复发的关系。结果CSDH术后复发与术前硬膜下血肿厚度及中线移位程度无关。术后7d硬膜下腔宽度≥1cm或硬膜下腔积气超过硬膜下腔体积的20%者,复发率明显增高。术后闭式引流管头端置于额叶皮层处复发率最低。结论闭式引流管头端置于额叶皮层处可以通过排除颅内积气,达到减少术后血肿复发的目地。术后7d复查头颅CT,对预测术后复发概率大有裨益。

Objective To determine the best position of the catheter to achieve a low recurrence rate during subdural drainage for chronic subdural hematoma （CSDH）. Methods A retrospective study was done on 130 cases with CSDH in regard of preoperative thickness of CSDH, preoperative midline displacement, postoperative locations （forehead, temple, cupula and occiput） of the subdural drainage catheter, postoperative width of the subdural space and the relationship of the accumulated air in ipsilateral subdural space with postoperative relapse. Results The CSDH thickness and the midline displacement on preoperative CT scan had no correlation with the postoperative recurrence rate of CSDH. Seven days after operation, the width of the subdural space over 1 cm or the accumulated air of the subdural space exceeding 20% of the the subdural space volume would result in obvious increase of recurrence rate of CSDH. The catheter locating on the frontal lobe cortex postoperatively had the lowest recurrence rate of CSDH. Conclusions Postoperative recurrence of CSDH can be reduced by placing the tip of the drainage catheter on the frontal lobe cortex to remove subdural air during or after surgery. CT scanning at postoperative day 7 is helpful for determine recurrence rate.