慢性硬脑膜下血肿钻孔引流术后并发症的防治对比研究及文献复习

Prevention and treatment of surgical complications of burr-hole drainage for chronic subdural hematoma-a comparative study and literature review

目的探讨慢性硬脑膜下血肿（chronic subdural hematoma,CSDH）手术后并发症的类型及其防治措施。方法回顾性分析2003-2015年268例CSDH患者的临床资料,对术后并发症发生情况进行统计分析。结果 268例手术患者中出现并发症83例,发生率30.9%。常见并发症包括：颅内积气33例,硬膜下积液12例,脑复张不良13例,血肿复发4例,颅内血肿4例,脑脊液漏及低颅压4例;少见并发症有：引流管导致脑损伤2例,术中和术后癫痫各1例,脑梗死1例,术后精神障碍4例,钻孔引流失败2例,头皮感染1例,肺部感染死亡1例。格拉斯哥预后评分（GOS）恢复良好165例,偏瘫2例,死亡1例。改良术式组的并发症发生率显著低于常规术式组,差异有显著统计学意义（P〈0.01）,两组间GOS预后评分及平均住院日比较差异无统计学意义（P〉0.05）。结论针对CSDH患者进行个体化围术期管理,选择恰当的手术时机并作合理的技术改进,是提高CSDH患者治愈率,降低并发症发生率的关键。

Objective To investigate the types of postoperative complication of chronic subdural hematoma （CSDH） and the prevention and management of the complications. Methods The clinical data of 268 CSDH cases with surgical treatment between 2003 - 2015 were retrospectively reviewed and the postoperative complications were statistically analyzed. Results The postoperative complications occurred in 83 cases. The complication rate was 30. 9%. The common complications included pneumocephalus （n = 33 ）, subdural effusion（ n = 12） ,low brain re-expansion（ n = 13 ）, recurrent hematoma（ n = 4）, intracranial hematoma（ n = 4）and cerebrospinal fluid leakage and lower cranial pressure（ n =4）. The rare complications were drainage tube brain injury（ n =2） ,intraoperative（ n = 1 ） and postoperative epilepsy （ n = 1 ）, cerebral infarction （ n = 1 ）, postoperative mental disorders （ n = 4）, ineffective drainage （ n = 2）, scalp infection（ n = 1 ）and pneumonia that led to death（ n = 1 ）. The incidence of postoperative complications in improved surgery group was significant lower than that in conventional surgery group（ P 〈 0. 05）. However, the GOS score and the average length of hospital stay were not significantly different between the two groups （P 〉 0.05 ）. Conclusion Appropriate operation time arrangement,reasonable technical improvement and personalized perioperative management were the key to improve the cure rate and reduce the incidence of complications in patients with CSDH.