慢性硬膜下血肿3种治疗方法的疗效比较

Comparison with Three Treatment Means of Chronic Subdural Hematoma

目的:对119例慢性硬膜下血肿(CSDH)的临床资料,其中包括28例类固醇治疗成功的病例,进行比较,以期得出治疗该病的最有效方法。方法:将所有病例分成3个治疗组:冲洗引流组(A组,50例);冲洗抽吸引流组(B组,41例)和激素治疗组(C组,28例)。有91例接受手术治疗。28例接受类固醇治疗。对复发率等进行两两比较,采用Two-WayANOVA方差分析进行数据统计分析。结果:日常生活能力改善ADL评分,A组和B组差异无显著统计学意义;C组明显长于A组和B组(PA-C=0.035,PB-C=0.040)。复发率B组明显<A组(P=0.025),C组未见复发。复发时间A组和B组差异无统计学意义。结论:冲洗抽吸引流术是治疗CSDH复发率最低的外科治疗手段,类固醇治疗是效果肯定的内科保守治疗手段。

Aim. To present an in-depth analysis of clinical material of chronic subdural hematoma （CSDH）, including age, sex, symptom of onset, duration of therapy, type of treatment and the rate of recurrence. Treatment of CSDH of different conditions was suggested. The complication and proposed remedial measures to improve the effectiveness of this modality were analyzed. Methods. The study groups consisted of 119 patients （79 men, 40 women）, with a mean age of 63.4 years and a mean follow-up period of 72.5 months. 91 cases received burr hole operation, 28 cases received steroid therapy, 28 of them received pure medication therapy. Results： The recurrence rate of irrigation and drainage （A group） is 14.0% （7 cases of 50）, and the combination of irrigation, aspiration and drainage（B group） 2.4% （1 case of 41）. Compared with that of group A, the recurrence rate of group B is significant lower （PA-B=0.025）. There were 28 patients received the steroid therapy, no recurrence and complication occurred. Conelution： The combination of irrigation, aspiration and drainage seemed to be the best method for the surgical treatment of CSDH, the steroid therapy, as a supplement or alternative one of surgery, can provide significant recovery to the patient with CSDH.