机化型慢性硬膜下血肿九例临床诊治体会

Clinical diagnosis and treatment of nine patients with organized chronic subdural hematoma

目的探讨机化型慢性硬膜下血肿(CSDH)的病因、演变过程和手术治疗的经验及预后相关因素。方法通过对吉林大学第一医院神经创伤外科2006年6月至2016年6月所收治9例机化型CSDH的临床影像学表现/手术方式及术后疗效进行临床分析。结果除1例患者家属要求保守治疗外,其余8例患者均行开颅血肿清除,其中1例未切除脏层包膜硬膜下血肿术后7 d内复发,再次开颅手术治疗,完整切除脏层包膜,术后患者出现血氧饱和度下降、心率增快,家属放弃治疗,余7例患者完整切除包膜脏层及壁层恢复良好,无血肿复发及癫痫的并发症。结论机化型CSDH应手术开颅治疗,术中完整切除壁层及脏层包膜,掌握手术要点、正确预防及处理术后并发症。

Objective To study the causes of organized chronic subdural hematoma （CSDH） and the evolution and the experience of the surgical treatment and prognostic factors. Methods A retrospective study clinical analysis of 9 cases in the First Bethune Hospital of Jilin University from June 2006 to June 2016 of CSDH by the clinical imaging findings, surgical methods and postoperative curative effect. Results One patient＇s famiiy members require conservative treatment, the remaining 8 patients underwent craniotomy hematoma removal, of which 1 case without resection of the visceral layer of coated subdural hematoma in postoperative recurrence within 7 d, again craniotomy treatment, complete resection of the visceral layer of diolame, postoperative oxygen saturation decreased, heart rate increase, the family gave up treatment, 7 cases of complete resection and wall coated layer of dirty layer recovery is good, and no recurrence epilepsy hematoma occurred. Conclusion Craniotomy treatment of CSDH in the patients with organized CSDH, complete resection of the wall layer and the dirty layer of the diolame, grasp the main points of the operation, the correct prevention and treatment of postoperative complications.