两种不同术式治疗慢性硬脑膜下血肿的临床分析

Clinical analysis of the two different surgical methods for chronic subdural hematoma

目的探讨慢性硬膜下血肿(CSDH)的发病机制、临床特点和治疗方法。方法回顾性分析20年间前后两个阶段诊治的慢性硬脑膜下血肿316例,并从临床特点、影像学资料、预后、并发症以及两种手术疗效进行比较。结果87.3%的患者恢复良好,10.7%无改变或加重,病死率为1.9%。细孔钻孔+密闭式硬通道引流与颅骨钻孔+软管引流相比,术后并发症减少,再手术率低。结论细孔钻孔+密闭式硬通道引流手术,操作简单,用时短,安全有效,适合各年龄组,值得推广。

Objective To explore the pathogenesis,clinical features and surgical management of chronic subdural hematoma （ CSDH）. Methods A retrospective study was performed on 316 patients with CSDH in the last 20 years , evaluating the clinical characteristics,radiological findings, complications, surgical results and comparison of the efficacy of two different surgical methods ： burr-hole drainage with soft channel system （ 10mm ） , and microhole drainage of closed-hard channel system （ 2mm ）. Results 87.3% of the patients had good recovery, 10.7% of the patients showed no change or worsened, 1.9% of patients died. Compared with burr-hole drainage with soft channel system（ 10mm）, micro-hole drainage of closed-hard channel system（ 2mm） had less compications and reoperation. Conclusion Compared with burr-hole drainage of soft channel system, micro-hole drainage of closed - hard channel system with irrigation of the hematoma cavity is recommended. It is safe, efficient,less complications,timesaving, simple operation ,suitable for various age groups.