2种改良术式治疗慢性硬膜下血肿的临床疗效分析

Clinical efficacy of chronic subdural hematoma using two modified surgical procedures

目的介绍治疗慢性硬膜下血肿（CSDH）的2种改良术式，并探讨其临床疗效。方法南昌大学第二附属医院神经外科自2012年3月至2017年2月收治CSDH患者100例，其中43例行微创前后高低双孔对冲血肿清除＋T管挂壁引流术．57例行微创小骨瓣回纳血肿清除术。回顾性分析患者的临床资料和疗效。结果行微创小骨瓣回纳血肿清除术的57例患者中，53例患者术中均顺利清除血肿，4例患者血肿引流不畅，行扩大骨瓣血肿清除术。行微创前后高低双孔对冲血肿清除＋T管挂壁引流术的43例患者中，42例患者术中顺利清除血肿，1例患者血肿引流不畅，行扩大骨瓣血肿清除术。术后24h复查颅脑CT显示：同侧硬膜下积液36例（36％），同侧硬膜下少量积气13例（13％），原血肿腔少量血肿残留6例（6％）。术后随访3-6个月，原硬膜下积液、积气及残留血肿均完全吸收；无血肿复发、颅内感染、头皮切口感染患者，无死亡病例：对侧慢性硬膜下血肿1例（1％），经药物保守治疗后血肿吸收。所有患者的临床症状及体征均明显改善、消失。结论微创前后高低双孔对冲血肿清除＋T管挂壁引流术和微创小骨瓣回纳血肿清除术能有效治疗CSDH。术后并发症少，值得基层医院应用及推广。

Objective To introduce two modified surgical procedures for the treatment of chronic subdural hematoma （CSDH） and explore their clinical efficacies. Methods The clinical data of 100 CSDH patients, admitted to our hospital fi＇om March 2012 to February 2017, were retrospectively analyzed. Hematoma evacuation plus T-tube drainage was performed in 43 patients and minimally invasive microsurgery in 57 patients. Follow up of treatment efficacies was performed. Results During surgery, hematoma drainage of 5 patients （5%） was poor and the removal of hematoma was expanded. The clinical symptoms and signs of all of the patients improved after operation. Postoperative 24 h CT indicated that the ipsilateral subdural subdural effusion was found in 36 patients （36%）, a small amount of ipsilateral subdural air was found in 13 patients （13%）, and a small amount of residual hematoma was found in 6 patients （6%）. Follow up for 3-6 months indicated that subdural subdural effusion, subdural air and residual hematoma were absorbed completely; no hematoma recurrence, intracranial infection, scalp incision infection or death were noted; contralateral chronic subdural hematoma was found in one patient （1%）, and hematoma was absorbed after conservative treatment. Clinical symptoms and signs of all patients were significantly improved and disappeared. Conclusion The minimally invasive double-hole hemodilution assisted with T-tube wall-draining or minimallyinvasive hematoma evacuation can effectively treat CSDH, and the postoperative complications are few; the above two surgical methods are worthy of clinical use, especially application and popularization of primary hospital.