微创治疗老年人慢性硬膜下血肿88例

Minimally invasive treatment of 88 cases chronic subdural hematoma in the elderly

目的比较两种微创技术治疗60岁以上老年慢性硬膜下血肿126例的经验,并探讨其最佳的治疗方法。方法回顾性分析经皮微孔穿刺术治疗慢性硬膜下血肿92例,经皮微孔导管引流术治疗慢性硬膜下血肿34例。结果经皮微孔穿刺术组,在一个疗程中,穿刺3次共治愈86例(93.5%)。术后血肿腔内有急性出血2例(2%),血肿复发4例(4.5%),1例死于弥散性血管内凝血。经皮微孔导管引流术组,一次置管引流治愈31例(91%),好转3例(9%)。血肿复发1例(3%),1例合并肺炎死亡。无其它手术并发症。结论经皮微孔血肿穿刺术和经皮微孔导管血肿引流术治疗慢性硬膜下血肿的微创手术,因其创伤小,操作简单,疗效好,是老年患者首选的治疗方法。

Objective To introduce the experience of two kinds of minimally invasive surgical treatment of 126 patients with chronic subdural hematomas （CSDHs） aged 60 years old and to discuss the more effective surgical procedure for CSDH in the elderly. Methods Percutaneous micro - drill subdural tapping （PMST） in 92 cases and percutaneous micro - drill catheter drainage （PMCD） in 34 cases of CSDH were analyzed retrospectively. Results In PMST group, 86 cases（93.5% ） were cured by tapping three times. Two cases suffered from acute subdural hematoma after the operation. Of them, one died of disseminated intravascular coagulation. RecmTence of hematoma was recognized in four cases（4.5% ）. In PMCD group, 31 cases（91% ） were cured by drainage once and three eases（9% ）were improved. There were no operative complications. Hematoma recurred in one patient（3% ）. One patient died of pneumonia. Conclusions PMST and PMCD are minimally invasive surgical procedures for CSDH, and should be the first choice in the elderly due to simple, minimally invasive and good results.