高位钻孔持续冲洗引流与微创穿刺引流治疗老年慢性硬膜下血肿的对比研究

Comparative study of elderly patients with chronic subdural hematoma treated by high drilling hole irrigation-drainage and microinvasive craniopuncture

目的探讨应用高位钻孔持续冲洗引流与微创穿刺引流治疗老年慢性硬膜下血肿的疗效及并发症。方法回顾性分析2009年1月至2012年1月分别应用高位钻孔持续冲洗引流术(实验组,159例)及微创穿刺引流术(对照组,145例)治疗患者的临床资料,评价两组患者的临床疗效及手术并发症。结果两组患者入院及出院时临床神经功能缺损程度评分比较差异未见统计学意义(P>0.05);但两组入院及出院时比较差异有统计学意义(P<0.05);且出院时患者的临床症状缓解率达90%以上。对照组和实验组拔管后血肿腔残留血肿分别为22例(15.2%)和6例(3.8%),术后3 d颅内积气为20例(13.8%)和7例(4.4%),术后颅内血肿为15例(10.3%)和5例(3.1%),术中脑损伤为7例(4.8%)和0例(0%),差异有统计学意义(P<0.05);两组患者出院时脑组织膨胀不满意为32例(22.1%)和27例(17.0%),术后3个月复发为12例(8.3%)和7例(4.4%),差异未见统计学意义(P>0.05)。结论高位钻孔持续冲洗引流与微创穿刺引流术都是治疗慢性硬膜下血肿的有效方法,但高位钻孔持续冲洗引流术并发症少,手术安全性高,值得临床推广应用。

Objective To investigate the efficacy and complications of high drilling hole irrigation-drainage and microinvasive craniopuncture therapy of chronic subdural hematoma（CSDH）. Methods Retrospectively analyzed the clinical data of 304 patients with CSDH treated by high drilling hole irrigation-drainage（experiment group,159 cases）and microinvasive craniopuncture（control group,145 cases）from January 2009 to January 2012,the curative effects and operative complications of two groups were contras-ted and evaluated. Results Clinical nerve deficiency scale between the two groups had no significant difference at admission and discharge separately（P 〉0. 05）,but the difference of clinical nerve deficiency scale of each group between admission and discharge was significant（P 〈0. 05）. The cure rate of both groups was above 90% . Residual hematoma between the control group and the ex-perimental group occurred 22 cases（15. 2% ）and 6 cases（3. 8% ）respectively,intracranial pneumatosis on third day after surgery occurred 20 cases（13. 8% ）and 7 cases（4. 4% ）respectively,intracranial hematoma after surgery occurred 15 cases（10. 3% ）and 5 cases（3. 1% ）respectively,intraoperative brain injury occurred 7 cases（4. 8% ）and 0 case（0% ）respectively,these complica-tions had significant differences between the two groups（P 0. 05）. Conclusion High drilling hole irrigation-drainage and microinvasive craniopuncture have comfirmed effect,but high drilling hole irrigation-drainage has few complications and high operation safety,and is worthy to be popularized.