单孔钻颅冲洗并外引流术治疗慢性硬膜下血肿31例临床分析

Analysis of 31 Chronic Subdural Hematoma Patients Treated by Trepanation and Drainage

目的:探讨单孔钻颅冲洗并外引流术治疗慢性硬膜下血肿的临床效果。方法:选取31例慢性硬膜下血肿患者为研究对象,观察单孔钻颅冲洗并外引流术后患者的临床疗效及复发情况,分析临床疗效及影响血肿复发的因素。结果:31例患者治疗后神经功能分级较治疗前显著改善,比较差异有统计学意义(P<0.05);术后并发症包括2例颅内血肿,4例因脑萎缩导致硬膜下积液,2例非张力性气颅,1例癫痫,经保守治疗后缓解或消失。随访6个月,28例患者治愈,3例患者复发,复发率为9.68%。复发患者术前凝血功能障碍、颅脑CT显示血肿为混杂密度率、中线移位超过10mm的比例均高于治愈患者,比较差异有统计学意义(P<0.05)。结论:单孔钻颅冲洗引流术治疗慢性硬膜下血肿效果显著,术后并发症较低,术前凝血功能障碍、混杂密度血肿或中线移位较大等因素会影响治疗转归。

Objective： To explore the clinical experience and effect of trepanation and drainage for chronic subdural hematoma.Method： Clinical data of 31 patients with chronic subdural hematoma treated by trepanation and drainage were retrospectively analyzed.The clinical effect and factors that influence the recurrence were analyzed.Result： 31 cases of patients with neurological classification than before treatment significantly improved after treatment, comparing difference was statistically significant （ P〈O.05 ） .The complication included 2 cases of intracranial hematoma, 4 cases of subdural effusion, 2 cases of tension pneumocephalus, 1 case of epilepsia.With 6 months followed up, 28 patients cured and 3 patients recurred, recurrence rate was 9.7%.The coagulation dysfunction rate, the rate of inhomogeneous density hematoma on CT image and the rate of cerebral midline shift 〉I 10 mm were significantly higher in the patients with recurrent of CSDHs than those in the patients without recurrent of CSDHs, comparative difference was statistically significant （P〈0.05） .Conclusion： The trepanation and drainage surgery in chronic subdural hematoma is safe, effective, which complication and efficacy can he improved by taking attention to the factors as coagulation dysfunction, inhomogeneous density of hematomas on CT image and cerebral midline shift ≥10 ram.