慢性硬膜下血肿60例临床分析

目的探讨慢性硬膜下血肿的临床特征和手术治疗效果。方法综合分析慢性硬膜下血肿的临床特点、治疗方法。结果治愈54例，明显好转3例，死亡1例，并发对侧出血1例，术后再出血1例。结论慢性硬膜下血肿多为老年男性患者，大多无明显外伤史，颅骨钻孔引流效果好。     

扩大颅骨钻孔引流治疗慢性硬膜下血肿(附286例报告)

目的探讨扩大颅骨钻孔治疗慢性硬膜下血肿(CSDH)的方法。方法回顾性分析286例慢性硬膜下血肿手术,探讨手术方法。结果经CT扫描证实的286例慢性硬膜下血肿,行扩大颅骨钻孔引流,无1例死亡,术后头颅CT复查12例有颅内积气,无1例患者出现较严重的并发症。结论采用扩大颅骨钻孔引流治疗CSDH可以减少张力性气颅发生,亦可减少继发性出血等并发症。     

扭钻钻孔闭式引流治疗慢性硬膜下血肿

目的探讨扭钻钻孔后放置SubduralCatheterTM管闭式引流治疗慢性硬膜下血肿的疗效。方法对76例慢性硬膜下血肿病人采用颅骨钻孔SubduralCatheterTM 置管引流术。结果33例使用普通开颅钻孔术,6例因血肿复发需再次手术治疗;43例使用配套的专用扭钻钻孔,仅1例血肿复发,需再次手术。结论扭钻钻孔SubduralCatheterTM管闭式引流是治疗慢性硬膜下血肿的一种较佳方法,使用配套的专用扭钻可减少复发。     

双腔套管在慢性硬脑膜下血肿术中的应用

目的：探讨慢性硬脑膜下血肿的手术治疗方法。方法：回顾性分析84例慢性硬膜下血肿病人的临床特点、神经影像学资料、手术方法和结果。结果：84例病人首次手术均采用颅骨钻孔冲洗并闭式引流术，仅3例血肿复发后需再次手术处理，其中2例接受骨瓣开颅血肿手术后痊愈，1例术后死于癫痫并发肺炎。结论：颅骨钻孔双腔套管冲洗并闭式引流术是治疗慢性硬膜下血肿的首选方法，即使对术前发现血肿包膜增厚亦适用。骨瓣开颅血肿及包膜清除术适用于血肿壁坚厚、脑萎缩致脑膨起困难及分隔型血肿等情况。     

两种硬膜下引流方式治疗慢性硬膜下血肿的疗效分析

目的比较颅骨钻孔T管引流术和常规硬膜下引流术治疗慢性硬膜下血肿(CSDH)的临床治疗效果,为临床手术方式的选择提供参考。方法回顾性分析2011-12-2018-12驻马店市第一人民医院神经外科收治的108例CSDH患者的临床资料,按引流方法分为T管引流组和常规硬膜下引流组,并对相关变量进行统计学分析。结果 2组手术时间、住院时间、术后3个月Markwalder神经功能分级方面无显著性差异(P0.05)。T管引流组术后并发症发生率和血肿复发率均低于常规硬膜下引流组(P0.05)。结论两种手术方法均取得了较好的治疗效果,但T管引流术总体术后并发症发生率和血肿复发率均低于常规硬膜下引术,表明颅骨钻孔T管引流术可能是治疗CSDH更好的手术选择。     

细孔钻颅引流治疗慢性硬膜下血肿的体会

关于慢性硬膜下血肿的治疗问题,一般认为以手术治疗较为妥善。其手术方法有骨瓣成形开颅术,清除血肿并摘除血肿囊壁。还有采用一般颅骨钻孔,冲洗血肿引流的方法。近年来也有应用大剂量脱水药物及中草药等治疗方法。慢性硬膜下血肿大多呈陈旧的血性液体状态,在     

钻孔引流术在慢性硬膜下血肿的应用

慢性硬膜下血肿（chronic subdural hematoma，CSDH）系属外伤3w以后出现症状，位于硬脑膜与蛛网膜之间，具有包膜的血肿。CSDH是神经外科常见病症之一，好发于老年人和儿童，占颅内血肿的10％，占硬脑膜下血肿的25％，其中双侧血肿的发生率高达14％。慢性硬膜下血肿的治疗以颅骨钻孔引流术为首选，创伤小。我科2006年2月至2008年7月共收治62例慢性硬膜下血肿患者，采用钻孔治疗的方法，取得很好的效果。总结如下。     

颅骨钻孔T管挂壁引流术治疗慢性硬膜下血肿的疗效观察

目的 探讨颅骨钻孔T管挂壁引流术治疗慢性硬膜下血肿的疗效。方法 回顾性分析2012年1月至2017年6月采用颅骨钻孔T管挂壁引流术治疗的58例慢性硬膜下血肿的临床资料。结果 58例均顺利清除血肿。术后24~48 h复查头颅CT,同侧硬膜下积液（术中冲洗液）30例,同侧硬膜下少量积气8例,原血肿腔少量血肿残留10例。术后随访3~6个月,原硬膜下积液、积气、残留血肿完全吸收;2例复发,再次手术后好转。所有临床症状均明显改善、消失。结论 颅骨钻孔T管挂壁引流术治疗慢性硬膜下血肿,有效且简单易行,术后并发症少。     

颅骨钻孔微创术引流治疗慢性硬膜下血肿50例报告

目的 :应用颅骨钻孔置管冲洗引流术治疗慢性硬膜下血肿。方法 :5 0例患者均采用颅骨钻孔插入硅胶引流管 ,冲洗引流血肿 ,术后根据引流液情况留管 48～ 72h。结果 :5 0例均获治愈出院 ,且跟踪无复发。结论 :应用颅骨钻孔置管冲洗引流术治疗慢性硬膜下血肿疗效确切 ,适合各级医院开展     

高龄患者慢性硬膜下血肿手术治疗68例

目的探讨高龄患者慢性硬膜下血肿的临床特征和手术治疗。方法对我院自2000年至2009年手术治疗慢性硬膜下血肿68例进行回顾性分析。68例中,63例病人采用钻孔引流术治疗,5例采用小骨窗开颅血肿及包膜清除术治疗。结果 68例中,治愈59例,好转6例,死亡3例。结论应重视高龄患者慢性硬膜下血肿的早期诊断,颅骨钻孔引流术是治疗高龄患者慢性硬膜下血肿的首选方法,小骨窗开颅血肿及包膜清除术适于用血肿内有分隔、壁厚或已钙化者。     

Single versus double burr hole drainage of chronic subdural hematomas. A study of 267 cases

A spectrum of surgical techniques has been used in the management of chronic subdural hematomas. Single burr hole and double burr hole drainage are among the commonest techniques. A retrospective analysis of 267 patients with chronic subdural hematomas treated surgically by either single or double burr holes was performed. Recurrence rates of subdural hematomas treated either with single or double burr holes were not significantly different (χ²; p > 0.05). Thus, the number of burr holes does not affect the post-operative recurrence rate of chronic subdural hematomas. Both techniques are equally effective treatments.     

微创钻孔密闭引流手术治疗慢性硬膜下血肿临床疗效观察

目的探讨观察微创钻孔密闭引流技术在慢性硬膜下血肿治疗中的应用价值。方法按入选标准及课题研究方案选取124例CSDH患者,随机分为A组(单孔钻孔引流)和B组(双孔钻孔密闭引流),分别统计分析两组手术、拔管、留院时间,气颅、血肿复发率、神经康复等指标。结果⑴与B组相比,A组的患者在手术时间、住院时间相比明显少(P0.01);⑵与B组相比,A组的患者气颅发生率较少(P0.05),两组在血肿复发率无统计学差异(P0.05)。⑶与B组相比,A组患者神经康复指标BI和GOS较低(P0.01)。结论⑴微创钻孔密闭引流术(单、双孔)是治疗CSDH的行之有效的方法,⑵单孔密闭引流术在手术及留院时间、气颅发生率方面具有优势,而在3个月神经康复方面双孔引流较好。     

Complications of the chronic subdural hematoma.

Eighty three chronic subdural hematomas, obtained by surgery or by necropsy, were examinated. The patient age distribution curve of the non-complicated operative cases showed the highest incidence in the first year of life and also a moderate increase in the elderly group. Recurrent hemorrhage in the walls and in the cavity, was observed in twenty of the seventy three non-complicated cases of chronic subdural hematoma. In five cases the membranes and the subdural sac were invaded by leucemic cells and in the five remaining ones the hematoma was transformed in a subdural empyema. All these complicated subdural hematomas showed evidence of recurrent bleeding, suggesting that the leucemic cells or the infectious agent had spread to the subdural space by this way.     

Irrigation vs. closed drainage in the treatment of chronic subdural hematoma.

A number of different techniques are used to treat chronic subdural hematomas surgically. In this study, 70 chronic subdural hematomas were surgically treated and analyzed prospectively. Patients were classified according to clinical features and computed tomography images. Results of the cases that underwent burr-hole craniostomy-irrigation (group A; n=35) were compared with those undergoing burr-hole craniostomy-closed system drainage (group B; n=35). The most common etiological factor was trauma in both groups. Complete resolution in the early period was higher in group B compared to group A (60% vs. 40%). However, no difference was noted at the first month-follow-up. Recurrence rates were 17% in group A and 14% in group B. No significant difference was noted in terms of hospitalization duration or postoperative complications. In conclusion, we believe that the burr-hole craniostomy-irrigation technique is a reliable and effective method compared to burr-hole craniostomy-closed system drainage in the treatment of chronic subdural hematoma.     

术中腰穿注林格溶液治疗慢性硬膜下血肿的研究

本研究从1993～1995年对52例慢性硬膜下血肿进行手术治疗。随机分为2组:注液组26例,采用单孔钻颅,术中腰穿注入林格溶液,血肿冲洗,不放引流的方法,对照组26例,采用双孔钻颅,血肿引流的方法。结果表明:注液组术后脑组织复位,临床症状和体征恢复均较对照组显著增快,无血肿复发及并发症,且术终颅压监测在正常范围。将血肿液和最后一次冲洗液分别进行了渗透压和纤溶功能测定,同时与静脉血作对比,证明血肿局部纤溶功能亢进在CSDH病因中起重要作用,提出术中腰穿注液使脑组织早期复位和同时彻底的血肿腔冲洗使大量的组织型纤溶酶原激活剂(t-PA)和纤维蛋白特异性降解产物(D-二聚体)得以清除是手术效果良好、无血肿复发的关键。     

IL-6和VEGF在慢性硬膜下血肿中的检测及意义

目的 探讨慢性硬膜下血肿（CSDH）患者白介素-6（IL-6）和血管内皮生长因子（VEGF）表达及意义。方法 选取CSDH患者20例,均行钻孔引流术治疗,术中在骨孔内全层切取硬膜和血肿外膜,采用HE染色和免疫组化染色检查VEGF表达。选取同期健康体检者10 例作为对照。采集CSDH患者血肿液和外周血以及对照组外周血,应用酶联免疫吸附法检测IL-6和VEGF浓度。结果 CSDH患者血肿外膜可见嗜酸性粒细胞、毛细血管增生及大量红细胞渗出;血肿外膜VEGF表达呈强阳性。CSDH血肿液和外周血IL-6和VEGF浓度均明显高于对照组（P<0.01）,而且,CSDH患者血肿液IL-6和VEGF浓度明显高于其外周血浓度（P<0.01）。结论 CSDH患者血肿腔IL-6与VEGF含量增高,提示IL-6与VEGF可能相互促进,共同参与CSDH的形成。     

改良T型乳胶管治疗慢性硬膜下血肿

目的研究改良T型乳胶管对慢性硬膜下血肿的治疗效果。方法回顾性分析我院神经外科2000年1月～2010年1月收治并行钻孔引流术（BHID）的慢性硬膜下血肿病人共169例，其中用改良T型乳胶管引流的共91例，用侧孔橡皮管引流的共78例。结果改良T管组和MffL橡皮管组的术后颅内积气积液和术后复发率有统计学差异，术后颅内感染率无显著差异。结论改良T型乳胶管对慢性硬膜下血肿有较好的治疗效果。     

Autogenic bone plug to seal burr holes: technical note

Many neurosurgical procedures can be performed by a single burr hole: neuro-endoscopy, microvascular decompression, stereotactic procedures, chronic subdural haematomas. It is technically difficult to suture and close the dura, located at the bottom of such holes, which can lately lead to CSF leakage. On the other hand, the surgical material used to seal the burr holes can be divided in heterogenic (metal screws, silicon plugs, gelfoam, bone wax, metilmetacrilate, hydroxyapatite), and autogenic (fat, aponeurosis, muscle, and bone dust from trephination). The heterogenic group always brings the possibility of foreign body reaction, which can complicate the procedure lately, ensuing a new surgical procedure to clean up the area. It also favors infection. We present a simple, economic, and biologically compatible "autogenic bone plug" to seal burr holes using the bone dust from the original trephination packed with surgical. The incidence of CSF fistulae on that procedures performed by a single burr hole lowered to almost zero, and foreign body reaction was not observed to present.     

Endoscopic burr hole evacuation of an acute subdural hematoma

Acute subdural hematoma evacuations frequently necessitate large craniotomies with extended operative times and high relative blood loss, which can lead to additional morbidity for the patient. While endoscopic minimally invasive approaches to chronic subdural collections have been successfully demonstrated, this technique has not previously been applied to acute subdural hematomas. The authors report their experience with an 87-year-old patient presenting with a large acute right-sided subdural hematoma successfully evacuated via an endoscopic minimally invasive technique. The operative approach is outlined, and the literature on endoscopic subdural collection evacuation reviewed.     

The relationship between coagulation time and bilateral occurrence in chronic subdural hematoma]

The relationship between the bilateral occurrence and coagulation time was analyzed in 137 cases of chronic subdural hematoma. Bilateral chronic subdural hematomas more frequently happened in the patient with coagulation time elongation beyond the normal control. This tendency was significant in the non-traumatic group and bilateral subdural hematomas were found in: 45% in prothrombin time (PT)-elongated group vs 10.3% in non-elongated group and 38.9% in activated partial thromboplastin time (aPTT)-elongated group vs 14.6% in non-elongated group. The ratio of PT and aPTT coagulation time against the normal control was significantly larger in the bilateral group than in the unilateral group. The ratio was as follows: PT ratio was 1.056 in bilateral group and 0.995 in unilateral group. aPTT ratio was 1.051 in bilateral group and 0.954 in unilateral group. Furthermore the bilateral hematomas tended to happen in hemodialysis cases, and in patients on warfarin or anti-platelet drugs. Bilateral hematomas were found in 41.7%, 37.5% and 33.3% respectively. The ratio of PT and aPTT coagulation time was as follows: PT ratio was 1.040 in hemodialysis cases and 1.082 in warfarin-applicated cases. aPTT ratio was 1.022 in hemodialysis cases and 1.055 in warfarin-applicated cases. These results suggest that the suppressed coagulation ability and platelet function are involved in the genesis of bilateral chronic subdural hematomas.