220例慢性硬脑膜下血肿病因分析和治疗方法探讨

The Investigation of Chronic Subdural Hematome Etiological Analysis and Treatment

报告２２０例慢性硬脑膜下血肿（ＣＳＤＨ），手术治疗２０７例，非手术治疗１３例，除１例死亡外，余２１９例均治愈。其中１６２例行大孔钻颅血肿冲洗引流，无一复发。认为ＣＳＤＨ血肿与蛛网膜破裂ＣＳＦ漏入硬膜下，使硬膜下腔扩大并使原有的硬膜下血肿溶解扩散有关；后期血肿扩大与导静脉多次破裂出血有关；血肿包膜外壁的改变，可能是血肿吸收过程中形成的肉芽组织的发生发展、吸收和纤维化的病理改变，而不一定是出血的主要原因。认为大孔钻颅血肿冲洗引流效果良好，可以避免血肿复发和血肿腔积气。

We analysed 220 cases′ clinical documents of CSDH,reviewed professional digests,investigated the cause of hematoma expansion and contrast different kinds of surgery operations 220 cases were healed and recoveried except one dead,none of 162 cases was recurrented improved craniotomy for irrigation of hematoma and drainage CSDH expansion is related to CSF transudating into the subduralcavity,through the hiatus of arachnoid,expanse the subdural cavity,dissolve and diffuse the original subdural hematoma In late period,hematoma expension is related to the periencephal vein and the emissary vein frequently rupturing and bleeding The change of the external wall of hematoma membrane is probably the pathological changes of the granulatius tissue as growing,absorpting and fibroisizing and should not be the main factor of bleeding