局部麻醉下行微创钻孔引流术治疗慢性硬膜下血肿的研究

Treatment of chronic subdural hematoma with minimally invasive trepanation and drainage under local anesthesia

目的 慢性硬膜下血肿(CSDH)是神经外科的一种常见疾病,通常发病于老年人群。CSDH患者血肿的清除有多种手术方式。旨在研究CSDH患者行微创钻孔引流手术的效果及其预后。方法 对2013年1月1日至2022年12月31日在联勤保障部队第九〇三医院接受CSDH手术的患者进行的回顾性研究。采用描述性统计,确定术后疗效。结果 在符合纳入标准的115份病历中,23.5%为女性,男女比例为3.3∶1。98例患者年龄在55岁以上,平均年龄为59.6岁。最常见的症状是头痛,其次是肌力下降。CSDH通过头颅CT或MRI明确诊断。采用格拉斯哥预后评分(GOS)评估患者预后,85.6%的患者预后恢复良好。结论 局麻下行微创钻孔引流术是治疗CSDH的一种简单、安全、有效的手术方式,在紧急情况或条件有限的情况下,如在战场或灾害环境下可以解除急性脑疝风险。

Objective Chronic subdural hematoma(CSDH)is a common disease in neurosurgery and usually occurs in the elderly population.There are various surgical modalities for hematoma evacuation in CSDH patients.The aim of this paper is to investigate the simple,safe and effective procedure performed in hospital and its prognosis in patients undergoing CSDH surgery.Methods A retrospective study was conducted on patients who underwent CSDH surgery at the 903rd Hospital of the Chinese People's Liberation Army and the Third Medical Center of the Chinese PLA General Hospital from January 1,2013 to December 31,2022.Descriptive statistics were used to determine postoperative outcomes including length of hospital stay,complications,and recurrence rates.Results Of the 115 medical records included in the criteria,23.5%were female and the male to female ratio was 3.3∶1.Ninety-eight patients were over 55 years of age,with a mean age of 59.6 years at presentation.The most common symptom was headache,followed by decreased muscle strength.CSDH was diagnosed by cranial CT or MRI.Forty-eight(41.7%)patients had left-sided CSDH,51(44.4%)had right-sided CSDH,and 16(13.9%)had bilateral CSDH.The mean hospital stay was(13.68±2.6)days.Glasgow outcome scale was used to assess the prognosis of patients,and 85.6%of patients recovered well.Conclusion Minimally invasive trepanation and drainage under local anesthesia is a simple,safe and effective surgical method for the treatment of CSDH,which can relieve the risk of cerebral hernia in emergency situations or limited conditions,such as in the battlefield environment.