手术治疗老年人慢性硬膜下血肿若干问题探讨

Investigation of existing problems about operative treatment on old patients with chronic subdural hematoma

目的探讨老年人慢性硬膜下血肿的病因、病理特点和手术治疗的经验及疗效。方法对148例患者采用颅骨钻孔引流、骨瓣开颅血肿清除、微创穿刺引流方法进行手术治疗。结果术后24 h脑CT复查见硬膜下积液36例,不同程度颅内积气48例,急性硬膜外血肿5例,脑内血肿2例。症状性癫痫12例,精神障碍13例。患者出院时恢复均良好,症状明显缓解,出院后随访6个月,血肿复发8例。结论老年人慢性硬膜下血肿手术治疗应因人而异,选择合适的手术方式,掌握手术要点,正确处理术后并发症。

Objective It is to investigate the etiopathogenisis, pathology and effect of surgical treatment in old patients with chronic subdural hematoma. Methods 148 patients were underwented different surgical treatments such as sphenotresia drainage, craniotomy evacuation of hematoma, mini-invasive drainage. Results All patients under went head CT scan 24 hours after surgery, there were 36 cases with postoperative subdural effusion, 48 cases with intracranial gas, 5 cases with a- cute epidural hematoma, 2 cases with intracerebral hematoma; in addition, there were 12 cases with symptomatic epilepsy and 13 cases with mental disorders, they all recovered when discharged from hospital, with symptoms relieved. 8 cases were relapsed within 6-month follow-up. Conclusion The treatment of old patients with chronic subdural hematoma should be according to individualization doctrine, and select appropriate operative techniques, master the main point of operation, timely and correct treat complications.