症状性慢性硬膜下血肿钻孔术后膜下引流与骨膜下引流疗效分析

Efficacy analysis of subdural drainage or subperiosteal drainage in symptomatic chronic subdural hematoma

目的比较有症状慢性硬膜下血肿(CSDH)采用硬膜下持续引流和骨膜下引流的疗效,并探讨手术并发症等安全性。方法2014年1月至2019年1月我院神经外科收治的CSDH钻孔后骨膜下持续引流患者86例作为观察组;同期行CSDH钻孔硬膜下持续引流的患者112例作为对照组。比较两组血肿复发、再次手术、开颅手术、颅内血肿、对侧硬膜下血肿、颅内感染、尿路感染、肺部感染、切口感染、死亡等指标。结果两组间在手术并发症方面无明显统计学差异(P>0.05);而进一步亚组分析发现在口服抗凝剂或抗血小板药物的患者中,对照组硬膜下引流血肿复发率高于观察组,差异有统计学意义(P<0.05);在≥80岁高龄患者中,观察组骨膜下引流死亡率低于对照组硬脑膜下引流,差异有统计学意义(P<0.05)。结论硬膜下引流在高龄患者中死亡风险更低,对于使用抗凝或抗血小板治疗患者术后血肿复发风险高;而钻孔后骨膜下持续引流并未增加手术并发症发生风险,同时该方式手术操作更为简便,具有进一步推广的临床意义。

Objective To compare the effect between continuous subdural drainage and subperiosteal drainage in symptomatic chronic subdural hematoma(CSDH)and discuss the surgical complications and safety.Methods Eighty-six CSDH patents with subperiosteal continuous drainage at the department of neurosurgery of our hospital from January 2014 to January 2019 were taken as an observation group.At the same time,112 CSDH patients with subdural continuous drainage by drilling were served as a control group.Hematoma recurrence,reoperation,craniotomy,intracranial hematoma,contralateral subdural hematoma,intracranial infection,urinary tract infection,lung infection,and death were compared between the two groups.Results There was no statistically significant difference in surgical complications between the two groups(P>0.05).Further subgroup analysis found that the hematoma recurrence rate was higher in the subdural drainage group patients with oral anticoagulant or antiplatelet drugs(P<0.05).In elderly patients(age≥80 years old),the risk of subperiosteal drainage was lower after drilling than the subdural drainage group(P<0.05).Conclusion Compared with subdural drainage,continuous subperiosteal drainage after drilling does not increase the risk of surgical complications.At the same time,the operation is more convenient and has clinical significance for further promotion.