高龄患者慢性硬膜下血肿复发的危险因素及再次手术策略

Risk factors for chronic subdural hematoma recurrence and the reoperation strategies in elderly patients

目的探讨高龄患者慢性硬膜下血肿(CSDH)术后复发的危险因素及再次手术策略。方法2012年10月至2018年12月我院手术治疗高龄(年龄≥85岁)CSDH患者56例,其中术后血肿复发12例,其中再次手术11例,探讨再次手术策略及回顾性分析血肿复发的危险因素。结果复发患者的平均年龄与未复发患者比较差异无统计学意义(t=0.308,P=0.759);混杂密度与密度较均一两组比较差异有统计学意义(53.3%和12.8%,χ2=6.54,P=0.011);术前最大厚度大于1 cm小于2.5 cm与术前最大厚度2.5 cm及以上两组比较差异有统计学意义(12.5%和50.0%,χ2=4.753,P=0.029);术后1周最大厚度1 cm及以上与小于1 cm两组比较差异无统计学意义(31.0%和12.0%,χ2=1.823,P=0.177)。11例患者经再次手术治疗10例获得良好预后。结论高龄CSDH患者术后复发如无明显禁忌均可通过再次手术治疗来提高生活质量。

Objective To investigate the risk factors for chronic subdural hematoma(CSDH)recurrence and reoperation strategies in elderly patients.Methods From October 2012 to December 2018,56 patients aged 85 years and over with CSDHs undergoing surgery in our hospital were enrolled.After surgery,12 patients had hematoma recurrence,of whom 11 received reoperation.The strategies of reoperation and the risk factors of recurrence were analyzed.Results The average age was similar between patients with and without recurrence(t=0.308,P=0.759).However,the rates of recurrence between patients with mixed and with homogeneous density were significantly different(53.3%vs 12.8%,χ2=6.54,P=0.011),and there was also a significant difference in recurrent rate between patients with a small maximum thickness(1.0 cm to 2.5 cm)and those with a large maximum thickness(≥2.5 cm)before operation(12.5%vs 50.0%,χ2=4.753,P=0.029).Patients with a maximum thickness≥1.0 cm after surgery was associated with a comparable risk of hematoma recurrence compared with those with a thickness<1.0 cm(31.0%vs 12.0%,χ2=1.823,P=0.177).Most patients(10/11)achieved a good prognosis after reoperation.Conclusion Reoperation can improve the quality of life in elderly patients with CSDH recurrence and without obvious contraindications.