钻孔虹吸冲洗引流治疗慢性硬膜下血肿疗效观察

Trepanation and drainage by siphon flushing method for treatment of chronic subdural hematoma

目的探讨钻孔引流术虹吸冲洗法治疗慢性硬膜下血肿(CSDH)的临床疗效。方法回顾性分析自2008年1月至2014年1月内蒙古鄂尔多斯市中心医院神经外科收治的115例CSDH患者,随机分为常规冲洗组和虹吸冲洗组。观察并比较两组患者手术前后扩展格拉斯哥结局量表(GOSE)评分、手术时间、住院时间以及复发例数。结果两组患者术后均未发生严重并发症,无患者死亡。虹吸冲洗组手术时间短于常规冲洗组,差异有统计学意义(P<0.05)。术后7 d,虹吸冲洗组GOSE评分≥7分患者例数多于常规冲洗组,差异有统计学意义(P<0.05)。虹吸冲洗组住院时间明显短于常规冲洗组,差异有统计学意义(P<0.05)。虹吸冲洗组复发例数明显少于常规冲洗组,差异有统计学意义(P<0.05)。结论钻孔引流术中虹吸冲洗法治疗CSDH可以明显提高临床疗效,且术后复发率低,并发症少,值得推广使用。

Objective By comparing the two methods of conventional irrigation and siphon irrigation in the treatment of chronic subdural hematoma（ CSDH）,the curative effect of siphon drainage in the treatment of CSDH is better. Methods Retrospective analysis of patients with CSDH in neurosurgery of our hospital from January 2008 to January 2014. Diagnosed by CT / MRI,115 patients with CSDH were randomly divided into two groups,one group using a drill conventional washing drainage（ group A： n = 56）,another group using the drilling drainage of siphon flush（ group B： n = 59）. After giving the same routine anti-infective and Ringer＇s solution（ 1000 ml,routine three days to promote the complex brain swelling）,indwelling drainage tube was removed after 48 hours. All the patients were assessed preoperatively / postoperatively,by using extended Glasgow Outcome Scale（ GOSE）,the operation time,hospital stays and the recurrence cases. Patients received follow-ups for 3 to 18 months to be observed outcomes. Results There was no seriously postoperative complication or death.For the preoperative group A and group B,GOSE rating≥7or≤6 the number of cases was analyzed,the two groups（ P〉0. 05）,which were not statistically significant. A week after,the GOSE assessment of patients≥7 to 42 cases（ 75. 0%）,≤6 of 14 cases（ 25. 0%）; in group B,GOSE rating≥7 to 57 cases（ 96. 6%）,≤6 for 2 cases（ 3. 4%）; group B could be seen in the cases with improved efficacy was significantly better than in group A; there was no significantly difference between the two groups（ χ^2= 11. 202,P〈0. 05）. Recurrence cases in group B were significantly less than in group A,and the difference between the two groups was statistically significant（ χ^2= 5. 341,P〈0. 05）. Length of hospital stay in group B was significantly less than in group A,the difference between the both groups was statistically significant（ P〈0. 05）. The operation time in group B is shorter than in group A. The difference was statistically significant（ P〈0. 05）. Conclusion Drill drainage of siphon flushing method utilized treatment of CSDH may significantly increase outcomes,decrease recurrence rate and complications,which could be widely used.