钻孔扩大骨孔冲洗引流术治疗117例慢性硬膜下血肿

117 cases of chronic subdural hematoma treated by irrigation and dranage through drilling and expanding skull hole

目的探讨慢性硬膜下血肿的手术治疗。方法对117例慢性硬膜下血肿患者,采用钻孔扩大骨孔硬膜下血肿冲洗引流术治疗,对术后并发症的发生原因及防止,以及手术疗效进行总结。结果117例均治愈。其中术后继发血肿4例,2例硬膜外血肿经保守治疗后血肿吸收,2例硬膜下血肿经骨瓣开颅血肿清除术后治愈;1例泥砂样慢性硬膜下血肿,引流术后血肿残存,经骨瓣开颅血肿清除术后治愈。术后气颅3例,经调整高位引流管位置引流及取患侧卧位后,积气吸收。结论应用钻孔扩大骨孔冲洗引流术治疗慢性硬膜下血肿,术野暴露充分、对硬脑膜进行悬吊、术中冲洗干净、直视下打开血肿壁及术后通畅引流,能减少术后并发症的发生及发展,获得较好的手术疗效。

Objective To discuss operative therapy for chronic subdural hematoma. Methods Irrigation and drainage of subdural hematoma by drilling and expanding skull hole was chosen for 117 cases of chronic subdural hematoma. Operative effectiveness and preventive tech of complications were analysised. Results All 117 cases were cured. Among them there were 4 cases hematoma succeeding operation,2 cases of subdural hematoma showed absolving after conservative treatment,another 2 cases were cured after evacuation of intracranial hematoma through skull flap. 1 cases of sediment chronic subdural hematoma remained hematoma after operation and was cured by evacuation of intracranial hematoma through skull flap. Conclusions Treating chronic subdural hematoma by irrigation and drainage of subdural hematoma through drilling and expanding skull hole demonstrates the following advantages. Operative field can be exposed sufficiently. Companying with ventrofixation of cerebral dura mater, sufficient irrigation, opening of the envelope of hematoma directly and smooth drainage, operative complications can be reduced. Better operative outcome can be expected.