慢性硬膜下血肿单孔与双孔钻颅外引流术疗效比较

Comparison of the curative effect between single hole and double holes drilling extracranial drainage for chronic subdural hematoma

目的探讨慢性硬膜下血肿单孔与双孔钻颅外引流术疗效。方法本研究探讨患者均属于我院慢性硬膜下血肿患者。收集2016年6月～2018年3月患者50例,25例对照组患者通过双孔钻颅外引流术予以医治,25例观察组患者应用单孔钻颅外引流术予以医治。分析不同的医治方案对患者手术时间、治愈率、住院时间、术后并发症、复发率等情况的影响。结果两组患者接收不同手术方式治疗后,观察组患者手术时间和住院天数均短于观察组患者。观察组患者中,2例术后并发肺部感染,2例并发消化道出血,1例并发泌尿系统感染。并发症发生率20%,对照组患者中术后并发肺部感染8例,2例并发消化道出血,1例并发泌尿系统感染,1例并发肾功能不全,并发症发生率48%比较,差异有统计学意义(P <0.05)。但两组患者复发率比较,差异无统计学意义(P> 0.05)。观察组患者治愈率为60%,高于对照组患者治愈率28%,差异有统计学意义(P <0.05)。结论单孔钻颅置管冲洗外引流术通常采取顶结节或血肿最厚层面处行一处头皮切口后钻单孔向前额方向置管冲洗外引流法,治疗慢性硬膜下血肿具有更大优势,手术时间短,风险低,并发症少,医疗费用下降。尤更适用于高龄,基础疾病多的患者。

Objective To discuss the curative effect between single hole and double holes drilling extracranial drainage for chronic subdural hematoma. Methods 50 patients with chronic subdural hematoma who admitted to our hospital from June 2016 to March 2018 were selected and divided into two groups.25patients in the control group received double holes drilling extracanial drainage treatment,another 25 patients in the observation group received single hole drilling extracanial drainage treatment.The effects of different treatment schemes on the operation time,cure rate,hospitalization time, postoperative complications and recurrence rate were analyzed. Results After receiving different surgical methods,the operation time and hospitalization days of patients in the observation group were shorter than those in the observation group.Among the patients in the observation group,2 cases were complicated with postoperative pulmonary infection,2 cases were complicated with gastrointestinal bleeding,and 1 case was complicated with urinary tract infection,with a complication rate of 20%.In the control group,8 patients were complicated with postoperative pulmonary infection,2 with gastrointestinal bleeding,1 with urinary tract infection,and 1 with renal insufficiency,with a complication rate of 48%.The difference between the two groups was statistically significant (P<0.05).There was no statistically significant difference in the recurrence rate between the two groups (P>0.05).The cure rate in the observation group was 60%, which was higher than that in the control group (28%, P<0.05). Conclusion Usually,a scalp incision is made at the thickest layer of the parietal tubercle or hematoma.After that,a single hole is drilled and the catheter is placed in the direction of the forehead for external drainage,which has more advantages,such as shorter operation time,lower risk,less complications and lower medical cost in the treatment of chronic subdural hematoma,especially suitable for elderly patients with more basic diseases.