双侧慢性硬膜下血肿微创治疗研究

Study on the minimally invasive treatment of bilateral chronic subdural hematoma

目的通过对双侧慢性硬膜下血肿的微创治疗分组对比,总结微创浣洗术与持续引流术的优缺点。方法回顾性分析2010年1月至2015年12月双侧慢性硬膜下血肿行微创穿刺手术患者88例。双侧血肿经额钻孔穿刺行微孔导管浣洗术56例(浣洗组),行常规双顶结节钻孔穿刺引流术32例(引流组)。术后浣洗组不做持续引流,每日浣洗血肿,引流组头低位持续引流,并复查头颅CT,据CT结果适时拔管。术后据GOS评分评估治疗效果。结果浣洗组一次性治愈48例(85. 7%),好转8例(14. 3%),有效率100%。引流组一次性治愈18例(56%),好转8例(25%),加重6例(19%),总有效率81. 25%。2组治愈率、血肿复发率、并发症发生率等方面差异有统计学意义(P <0. 05)。结论双侧慢性硬膜下血肿因其自身特点,浣洗组较引流组效果更好,复发率低,并发症少。

Objective To summarize the merit and demerit of micro-drill catheter wash and constant drainage by comparing the therapeutic effects of minimally invasive treament of bilateral chronic subdural hematoma in different methods.Methods The data about 88 patients with chronic subdural hematoma who were treated in our Hospital from January 2010 to December 2015 were retrospectively analyzed.The 88 patients were divided into catheter irrigation group(n=56)and constant drainage group(n=32)).The 56 patients in catheter irrigation group were treated by micro-drill catheter wash after bilateral hematoma transfrontal craniopuncture and drainage operation,,however,the 32 patients in constant drainage group were treated by routine bilateral parietal eminence drilling puncture drainage.After surgery the therapeutic effects were evaluated according to GOS scores.Results The 48 patients(85.7%)were cured once in catheter irrigation group,8 patients were improved,with total effective rate being 100%,however,18 patients(56%)were cured once in constant drainage group,8 patients were improved,aand 6 patients were aggravated,with total effective rate being 81.25%,there were significant differences in cure rate,hematoma recurrence rate,incidence rate of complications between the two groups(P<0.05).Conclusion The therapeutic effects of catheter irrigation after surgery of bilateral chronic subdural hematoma are superior to those of constant drainage,the former has lower recurrence and fewer complications.