钻孔引流治疗慢性硬膜下血肿50例分析

目的探讨颅内血肿钻孔引流治疗慢性硬膜下血肿并发症的预防和治疗方法。方法总结分析钻孔引流治疗50例慢性硬膜下血肿的临床资料。结果治愈率96%,复发率9%,并发症发生率15.4%,病死率1.2%。结论钻孔引流治疗慢性硬膜下血肿是一种安全、简单、有效的方法。     

微创穿刺引流治疗慢性硬膜下血肿

目的探讨微创穿刺引流治疗慢性硬膜下血肿患者的效果。方法使用YL-1型一次性颅内血肿粉碎穿刺针,对48例慢性硬膜下血肿患者行微创穿刺引流术。结果48例慢性硬膜下血肿均经微创穿刺治愈,47例一次性治愈,1例拔除穿刺针后出现张力性气颅,因发现及时,从原穿刺孔置入穿刺针引流后治愈。无复发,未出现颅内感染等并发症。血肿清除所需时间为2～4天。结论微创穿刺引流治疗慢性硬膜下血肿患者效果满意,其操作简单,并发症少,值得临床推广。     

微创置管联合三通引流治疗慢性硬膜下血肿

目的探讨微创置管联合三通引流治疗慢性硬膜下血肿的可行性. 方法局麻下自制套管针或骨锥等器械颅骨穿刺置管,联合三通密闭冲洗引流31例慢性硬膜下血肿. 结果全组病人均痊愈,无颅内积气发生.随访3～6个月,无复发. 结论微创置管联合三通治疗慢性硬膜下血肿可行,既能充分清除血肿,又从根本上避免了颅内积气的发生.     

慢性硬膜下血肿钻孔引流改良的探讨

目的 探讨慢性硬膜下血肿钻孔引流改良的疗效.方法 回顾性分析用"T"型管引流慢性硬膜下血肿的疗效及并发症的发生.结果 治疗46例慢性硬膜下血肿经改良引流并发症少,操作简单.结论 慢性硬膜下血肿经改良"T"管引流价格低廉,取材方便,并发症少,适合在基层医院开展.     

钻孔引流术与微创引流术治疗慢性硬膜下血肿的比较

目的比较不同手术方式治疗慢性硬膜下血肿（chronic subdural hematoma,CSDH）的临床效果。方法回顾性分析2002年3月～2008年1月155例慢性硬膜下血肿的临床资料,其中传统钻孔引流术61例,应用3 mm克氏针引导置入细硅胶管行微创置管引流术44例,应用YL-1型微创颅内血肿穿刺针行微创穿刺引流术50例。比较3组术后颅内积气、颅内血肿、血肿复发和格拉斯哥预后分级（GOS）。结果颅内积气发生率钻孔引流组[（52%（32/61）]高于2个微创引流组[7%（3/44）,18%（9/50）]（x^2=30.110,P=0.000）,但无一例张力性气颅,均短时自行吸收。术后颅内血肿及血肿复发钻孔引流组均为0,明显低于2个微创引流组[11%（5/44）,10%（5/50）,x^2=7.009,P=0.030;14%（6/44）,10%（5/50）,x^2= 8.153,P=0.017]。3组GOS无显著差异（x^2=0.489,P=0.783）。结论3组治疗效果相近,均为治疗慢性硬膜下血肿安全有效的手术方式。     

多点对冲引流治疗外伤性颅内血肿

目的探讨多点对冲引流治疗外伤性颅内血肿的疗效. 方法 2003年2～9月我院应用YL-1型一次性颅内血肿粉碎穿刺针同时进行2～3针穿刺对冲引流治疗28例外伤性颅内血肿. 结果治愈25例,治愈率89.3%(25/28),改开颅手术3例,其中死亡2例. 结论多点对冲引流治疗外伤性颅内血肿微创、安全、有效.     

微创治疗慢性硬膜下血肿83例

目的总结微创方法治疗慢性硬膜下血肿的临床经验。方法应用YL-1型一次性颅内血肿粉碎穿刺针,选择合适位置穿刺进入血肿腔,抽出适量血肿并以生理盐水反复冲洗至清亮后,外接引流管引流。结果 83例患者均恢复良好,效果满意。结论采用微创术治疗慢性硬膜下血肿,方法简单,创伤小,痛苦轻,疗程短,费用低,疗效可靠。     

不同手术方式治疗慢性硬膜下血肿效果观察

目的分析两种不同术式治疗慢性硬膜下血肿的效果。方法选取48例慢性硬膜下血肿患者,按照住院时间阶段和手术方式分为2组,各24例。对照组使用钻双孔冲洗引流手术,观察组)应用YL-1型微创穿刺针穿刺引流手术。比较2组一次治愈率、术后住院时间、并发症发生率等。结果 2组患者一次治愈率差异无统计学意义(P0.05),观察组术后住院时间、并发症发生率少于对照组,2组比较,差异有统计学意义(P0.05)。结论应用YL-1型微创穿刺针穿刺引流术治疗慢性硬膜下血肿,具有创伤小,术后并发症发生率低、患者恢复快等优点。     

钻孔尿激酶注入引流联合阿托伐他汀钙治疗慢性硬膜下血肿的临床研究

目的探讨钻孔尿激酶注入引流联合阿托伐他汀钙对慢性硬膜下血肿的疗效及预后。方法收集我院自2014年1月~2016年12月收治的慢性硬膜下血肿患者230例,随机分为研究组和对照组,每组各115例。对照组患者给予单纯钻孔引流治疗,研究组给予钻孔尿激酶注入引流联合阿托伐他汀钙口服治疗,观察两组患者的疗效、血肿复发及并发症情况,以及患者的住院时间及住院费用。结果研究组患者的总有效率是96.65%,优于对照组患者的总有效率(84.35%)。研究组患者血肿复发率、总并发症发生率、住院费用及住院时间均低于对照组,差异均有统计学意义(P<0.01)。结论利用钻孔尿激酶注入引流联合阿托伐他汀钙口服治疗慢性硬膜下血肿,效果明显优于单纯钻孔引流治疗,使血肿复发率和术后并发症发生率明显降低,并缩短患者的住院时间,从而降低住院费用,值得临床推广应用。     

锥颅置SUBDURAL CATHETERTM管引流治疗慢性硬膜下血肿

慢性硬膜下血肿(chronic subdural hematoma,CSDH)是神经外科临床常见病,约占颅内血肿的10%.目前冲洗引流术已被广泛应用,是一种较可靠的方法.本院于2002年9月至2003年11月间,采用自制锥颅(槽手锥)器锥颅,置SUBDURAL CATHETERTM管(硬膜F专用引流管)闭试引流术治疗慢性硬膜下血肿22例,效果满意.现就SUBDURAL CATHETERTM管在慢性硬膜下血肿治疗中的应用介绍如下.     

A comparative study of the treatment of chronic subdural hematoma—burr hole drainage versus burr hole irrigation

BACKGROUND

Several surgical procedures have been reported for the treatment of chronic subdural hematoma. Whether irrigation is required is not clear. We compared the results of treatment of chronic subdural hematoma obtained with burr hole drainage and burr hole irrigation retrospectively.

METHODS

Forty patients with chronic subdural hematoma underwent surgery at our institution in the last 3 years. The first 20 patients were treated by burr hole irrigation (irrigation group), while the last 20 patients underwent burr hole drainage (drainage group). The rates of recurrence, changes in hematoma size, and number of days of postoperative hospitalization for the two groups were compared. No significant differences were found between the two groups in the presence of head injury, alcohol consumption, age, gender, or preoperative hematoma size.

RESULTS

Duration of postoperative hospitalization was 14.1 days in the drainage group and 25.5 days in the irrigation group. Recurrence was observed in 1 case (5%) in the drainage group, and in 5 cases (25%) in the irrigation group. In the drainage group, postoperative hematoma size was significantly decreased compared to preoperative hematoma size on the first postoperative day, after which change in hematoma size was minimal. On the other hand, in the irrigation group, hematoma size was decreased on the first postoperative day, but not to a significant extent.

CONCLUSION

For treatment of chronic subdural hematoma, postoperative hospitalization was shorter and the recurrence was less frequent with drainage than with irrigation.     

慢性硬膜下血肿钻孔引流术的手术技巧及其术后常见并发症的防治

目的探讨慢性硬膜下血肿钻孔引流术的手术技巧与术后常见并发症的防治。方法对我院10年来手术治疗的46例慢性硬膜下血肿病例进行回顾性分析。结果原手术治疗的26例中,术后多量颅内积气及硬膜下积液11例,血肿复发2例,脑梗塞2例,脑实质损伤术后死亡1例。术式改良后20例中,术后少量颅内积气积液4例,均短期内吸收。结论如果慢性硬膜下血肿引流术手术技巧的改良能正确应用,它将有利于防止或减少术后的并发症的发生。     

Single burr hole irrigation without drainage in chronic subdural hematoma

The surgical treatment of chronic subdural hematoma has evolved from membranectomy through craniotomy to burr hole irrigation. The latter approach is based on utilization of the natural absorptive process that is thought to be part of the life cycle of the hematoma. To test this theory, the authors treated fifty-nine patients with chronic subdural hematoma according to the following protocol. Local anesthesia was induced with a modified neuroleptanalgesic procedure. A single burr hole was drilled, usually in the posterior frontal region, and irrigation was carried out until the washing was clear. Subdural drainage was not employed. Patients were permitted to walk about on the following day. The outcome was better than that achieved with conventional treatment. Such complications as tension pneumocephalus and intracranial hematoma were not observed, and only one patient (1.7%) had a recurrence. The results of this study indicate that single burr hole irrigation without drainage is a very simple and effective treatment for chronic subdural hematoma. The absence of subdural drainage may be an important feature, since drainage may contribute to the development of certain postoperative complications. Also, the simplified procedure allows patients early mobility, which may be of particular benefit to the elderly.     

A comparative study of the treatment of chronic subdural hematoma--burr hole drainage versus burr hole irrigation

BACKGROUND: Several surgical procedures have been reported for the treatment of chronic subdural hematoma. Whether irrigation is required is not clear. We compared the results of treatment of chronic subdural hematoma obtained with burr hole drainage and burr hole irrigation retrospectively. METHODS: Forty patients with chronic subdural hematoma underwent surgery at our institution in the last 3 years. The first 20 patients were treated by burr hole irrigation (irrigation group), while the last 20 patients underwent burr hole drainage (drainage group). The rates of recurrence, changes in hematoma size, and number of days of postoperative hospitalization for the two groups were compared. No significant differences were found between the two groups in the presence of head injury, alcohol consumption, age, gender, or preoperative hematoma size. RESULTS: Duration of postoperative hospitalization was 14.1 days in the drainage group and 25.5 days in the irrigation group. Recurrence was observed in 1 case (5%) in the drainage group, and in 5 cases (25%) in the irrigation group. In the drainage group, postoperative hematoma size was significantly decreased compared to preoperative hematoma size on the first postoperative day, after which change in hematoma size was minimal. On the other hand, in the irrigation group, hematoma size was decreased on the first postoperative day, but not to a significant extent. CONCLUSION: For treatment of chronic subdural hematoma, postoperative hospitalization was shorter and the recurrence was less frequent with drainage than with irrigation.     

Intraoperative lumbar injection of Ringer's solution for surgical treatment of chronic subdural hematomas

A series of 64 patients underwent surgical treatment for chronic subdural hematomas between 1980 and 1989. The procedure consisted of a single burr-hole, irrigation of the hematoma without subdural drainage and lumbar intrathecal injection of Ringer's solution. Irrigation was carried out until the washing was clear and the injection was continued until the brain was in contact with the edge of the burr-hole. Excellent outcome was achieved in 53 patients (82.8% of the total). Two of the patients died, thus making a 3.1% mortality rate. Such complications as tension pneumocephalus and intracerebral hematoma were not observed and no patient had a recurrence.     

Various surgical treatments of chronic subdural hematoma and outcome in 172 patients: is membranectomy necessary?

BACKGROUND: The initial surgical management of chronic subdural hematoma (CSDH) is still controversial, and a standard therapy does not exist. Because of the advanced age and multiple medical problems of the patients, surgical therapy is frequently associated with complications. METHODS: A retrospective study was performed on 172 patients with CSDH, comparing the efficacy of three different primary surgical methods: drainage of hematoma through two different burr-holes without membranectomy (Group A, n = 38); enlarged craniectomy with a size of about 30 mm craniotomy with partial membranectomy and drainage (Group B, n = 121); and extended craniotomy with partial membranectomy and drainage (Group C, n = 13). RESULTS: Independent of surgical method, the general outcome of the patients was good. The rate of reoperation in the group of burr-hole drainage was 16%, slightly lower than in partial membranectomy with enlarged craniectomy or extended craniotomy with 18% and 23%, respectively. In patients with coagulopathy, the rate of reoperation was 41% (16/43), significantly higher than the rate in noncoagulopathic patients 12% (15/129). CONCLUSIONS: In this study, an extended surgical approach with partial membranectomy has no advantages regarding the rate of reoperation and the outcome. As initial treatment, burr-hole drainage with irrigation of the hematoma cavity and closed-system drainage is recommended. Extended craniotomy with membranectomy is now reserved for instances of acute rebleeding with solid hematoma.     

Efficacy of closed-system drainage in treating chronic subdural hematoma: a prospective comparative study

The authors conducted a prospective comparative study on the recurrence rate of chronic subdural hematoma after the use of two different treatment modalities: burr-hole irrigation of the hematoma cavity with (Group A) and without closed-system drainage (Group B). Thirty-eight patients were studied. Patients were assigned to groups sequentially upon admission. There were no significant differences between the two groups for age, sex, preoperative hematoma volume, and density on computed tomographic scan. One patient in Group A (5%) suffered a recurrence as opposed to 6 in Group B (33%). The difference in recurrence rate between the two groups was statistically significant (P less than 0.05). The authors conclude that closed-system drainage after burr-hole irrigation reduces the recurrence rate of chronic subdural hematoma.     

慢性硬膜下血肿钻单孔双管引流手术治疗体会

【摘要】〓目的〓探讨慢性硬膜下血肿钻单孔置双管外引流术的疗效。方法〓回顾性分析我院2011年6月~2014年3月收治69例慢性硬膜下血肿患者行钻单孔置双管引流手术治疗后的情况。结果〓58例临床症状体征消失,11例改善,无症状加重及死亡病例。经术后1~7天复查CT提示,69例血肿均大部份减少或基本消失,10例并发颅内血肿腔少量积气、积液,随访3个月全部恢复,无复发病例。结论〓慢性硬膜下血肿选择钻单孔置双管外引流效果良好,并发症较少。     

微创穿刺治疗慢性硬膜下血肿疗效观察

目的研究分析YL-1型微创针治疗慢性硬膜下血肿的临床疗效。方法对313例慢性硬膜下血肿患者采用YL-1型微创针治疗,回顾性观察其临床疗效。结果全部患者均治愈出院,随访观察中并发症发生率及复发率较低。结论 YL-1型微创针治疗慢性硬膜下血肿疗效确切,能有效减少术后并发症,值得临床推广。     

Iatrogenic acute subdural hematoma due to drainage catheter

BACKGROUND

Insertion of a catheter for drainage of a cavity is a routine step in many surgical practices. In neurosurgery, catheters are commonly placed in the subdural, subgaleal, or epidural spaces to prevent haematoma formation.

CASE DESCRIPTION

We present three cases of iatrogenic acute subdural hematoma. These were all related to the drainage catheters. In the first case, a subgaleal redivac suction catheter was used after craniotomy for brain abscess. The other two patients had ordinary ventricular catheters placed in the subdural space after burr hole drainage of chronic subdural hematoma. The drainage catheter was removed on postoperative day 5 in the first case and two days after the initial operation in the other two cases. Shortly after the removal of the drains, the conditions of the patients deteriorated rapidly due to the development of acute subdural hematoma.

CONCLUSION

Although they are extremely uncommon, life-threatening complications related to a drainage catheter are a real possibility. Therefore, the procedure should not be taken lightly.