双侧慢性硬膜下血肿单侧钻孔引流术后对侧血肿进展的危险因素分析

Analysis of risk factors for contralateral progression of bilateral chronic subdural hematoma after unilateral evacuation

目的探讨双侧慢性硬膜下血肿(bCSDH)单侧钻孔引流术后对侧血肿进展(CHP)的危险因素。方法回顾性研究2011年11月至2021年4月在首都医科大学附属北京天坛医院神经外科学中心接受单侧钻孔引流术的87例bCSDH患者的临床资料。术后3个月根据对侧血肿是否进展分为CHP组和无CHP组。对比分析两组患者临床资料的差异,对差异有统计学意义的变量采用多因素logistic回归方法分析影响CHP的相关危险因素。结果术后3个月,87例患者中16例发生CHP,发生率为18.4%,其中9例发生于术后1个月内,7例发生于术后1~2个月。5例患者经保守治疗血肿吸收,11例患者采用手术清除血肿。术后6个月内手术侧血肿复发2例,均为无CHP患者。与71例无CHP组患者对比,16例CHP组患者拔管前对侧血肿的最大厚度明显增大(P<0.001),对侧血肿位于曲侧(P=0.018)、血肿范围为广泛型(P=0.001)、CT密度为混杂型(P=0.034)患者的占比高。仅对术前的相关因素进行多因素logistic回归分析显示,对侧广泛型血肿(OR=5.34,95%CI:1.29~22.06,P=0.021)是CHP的危险因素;纳入术后变量进行分析后,对侧广泛型血肿(OR=4.60,95%CI:1.02~20.72,P=0.047)、拔管前对侧血肿最大厚度增大(OR=21.99,95%CI:1.85~260.81,P=0.014)是CHP的危险因素。结论bCSDH患者行单侧颅骨钻孔引流术后2个月内是CHP的高发期。对侧广泛型血肿、拔管前对侧血肿最大厚度增大是术后CHP的独立危险因素。

Objective To explore the risk factors for contralateral hematoma progression(CHP)after unilateral drilling drainage of bilateral chronic subdural hematoma(bCSDH).Methods A retrospective study was conducted on 87 patients with bCSDH who underwent unilateral drilling and drainage at the Neurosurgery Center of Beijing Tiantan Hospital,Capital Medical University from November 2011 to April 2021.Three months after surgery,the patients were divided into CHP group and non-CHP group according to whether the contralateral hematoma progressed.The clinical data and imaging data of the two groups of patients were compared and analyzed,and the multivariate logistic regression was used to analyze the risk factors affecting CHP for variables with statistically significant differences.Results Three months after surgery,16 of 87 patients developed CHP,with an incidence rate of 18.4%.Among them,9 cases occurred within 1 month after surgery,and 7 cases occurred 1 to 2 months after surgery.Five patients underwent conservative treatment for hematoma absorption,and 11 patients underwent surgical treatment to remove the hematoma.Among the patients with surgical treatment,8(72.7%)cases occurred within 1 month.There were 2 cases of hematoma recurrence on the operated side within 6 months after surgery,both of which were non-CHP patients.Compared with 71 patients in the non-CHP group,the maximum thickness of the contralateral hematoma before extubation was significantly increased in 16 patients in the CHP group(P<0.001);the contralateral hematoma was located on the curved side(P=0.018)and was extensive(P=0.001),and the CT classification was mixed type(P=0.034)with a high proportion.Multivariate logistic regression analysis of only preoperative related factors showed that extensive hematoma(OR=5.34,95%CI:1.29-22.06,P=0.021)was a risk factor for CHP;after including postoperative variables for analysis,extensive hematoma(OR=4.60,95%CI:1.02-20.72,P=0.047)and maximum thickness of contralateral hematoma before extubation(OR=21.99,95%CI:1.85-260.81,P=0.014)were the risk factors of CHP.Conclusions The period of high incidence of CHP in patients with bCSDH is within 2 months after unilateral cranial burr hole drainage.Extensive hematoma is an independent risk factor for CHP before surgery;the maximum thickness before extubation is also an independent risk factor for CHP after surgery.