头部外伤所致硬膜下积液的治疗

Treatment of Traumatic Subdural Effusion

【目的】探讨分析颅脑外伤后硬膜下积液的治疗方法。【方法】对51例外伤性硬膜下积液患者的临床及随访资料进行分析,其中21例行钻孔引流术,30例行保守治疗。【结果】钻孔引流21例患者,在医院治疗期间有3例痊愈,其余患者出院时未愈,1-6个月后随访有16例积液改善或治愈,有2例演变进入慢性硬膜下血肿。另外30例接受保守治疗,1-6个月后随访有25例积液改善或自愈,有3例演变成慢性硬膜下血肿,2例因积液增多有高颅压症状而行开颅手术,剥离包膜和撕裂蛛网膜开放外侧裂池,6个月后随访治愈。【结论】多数外伤性硬膜下积液可以保守治疗好转或治愈,少数有高颅压症状需手术治疗,手术方式以选择开颅剥离包膜并撕开蛛网膜打通颅底脑池的脑脊液循环较为合适,钻孔引流的治疗效果有限。

Objective To discuss therapy to manage traumatic subdural effusion.Methods There were 51 cases from Jan,2001 to Dec,2011,21 of them underwent drill drainage,30 cases underwent conservation therapy.Results Three cases with drill drainage got cured in hospital,others were uncured when leaving hospital.In 6 months,16 cases self-cured;25 of 30 cases with conservation therapy were cured in 6 months,2 cases underwent craniotomy and got cured after 6 months postoperatively.Conclusion Most patients with subdural effusion can get self-cured,a few with high intracranial pressure need therapy.Operation should be craniotomy,not drill drainage.