80岁以上单侧多分隔型慢性硬膜下血肿手术效果分析

Analysis of surgical results of over-80-year-old patients with unilateral multiple septated chronic subdural hematoma

目的通过与钻孔引流术比较,研究硬通道穿刺引流术治疗高龄多分隔型慢性硬膜下血肿(chronic subdural hematoma,CSDH)的有效性及安全性。方法21例80岁以上单侧多分隔型CSDH采用钻孔引流术治疗9例(钻孔组),采用硬通道穿刺引流术治疗12例(硬通道组),比较两组手术时间、术后1周血肿清除率、术后并发症及术后3个月血肿复发情况。结果两组患者均顺利完成手术,钻孔组手术时间50~95 min,平均(78±14)min,硬通道组22~40min,平均(29±5)min,差异有统计学意义(P<0.05);术后1周血肿清除率钻孔组92%~100%,平均(96%±3%),硬通道组90%~100%,平均(94%±3%),差异无统计学意义(P>0.05)。术后并发症钻孔组无癫痫发作,硬通道组癫痫发作1例(8.3%),差异无统计学意义(P>0.05);两组患者均无颅内占位性积气、脑实质损伤及颅内感染等其他并发症发生。术后3个月钻孔组无血肿复发,硬通道组复发3例(25%),差异无统计学意义(P>0.05)。结论硬通道穿刺引流术治疗高龄多分隔型CSDH安全有效,与钻孔引流术比较,其手术时间短、创伤小,更适合有重要脏器疾病的患者。

ObjectiveTo study the efficacy and safety of hard channel puncture drainage in the treatment of multiple septated chronic subdural hematoma(CSDH)in the elderly by comparison with drilling drainage.Methods Twenty-one over-80-year-old patients with unilateral multiple septated CSDH were treated with drilling drainage in 9 cases(drilling group)and hard channel puncture drainage in 12 cases(hard channel group).The operation time,hematoma clearance rate in 1 week after operation,postoperative complications and hematoma recurrence in 3 months after operation were compared between the two groups.ResultsThe two groups of patients successfully completed the operation.The operation time ranged from 50 to 95 min with a mean of(78±14)min in the drilling group and 22 to 40 min with a mean of(29±5)min in the hard channel group.The difference was significant(P<0.05);One week after operation,the hematoma clearance rate ranged from 92%to100%with a mean of 96%±3%in the drilling group and 90%to 100%with a mean of 94%±3%in the hard channel group.The difference was not significant(P>0.05).Postoperative complications:there was no epilepsy in the drilling group,and 1 epilepsy in the hard channel group(8.3%).The difference was not significant(P>0.05).There were no other complications such as intracranial space occupying gas,brain parenchyma injury,intracranial infection in both groups.Hematoma recurrence 3 months after operation:there was no recurrence in the drilling group and 3 cases(25%)in the hard channel group.The difference was not significant(P>0.05).ConclusionsHard channel puncture drainage is safe and effective in the treatment of elderly multiple septated CSDH.Compared with drilling drainage,it has shorter operation time,less trauma and is more suitable for patients with important organ diseases.