钻孔引流术治疗慢性硬膜下血肿临床体会

<正>慢性硬膜下血肿(chronic subdural hematoma,CSDH)是神经外科常见病症之一,好发于中老年人,首选治疗方法是钻孔引流术[1];我院自2011年1月至2013年7月收治CSDH患者93例,经钻孔引流治疗效果满意,现报告如下。一、对象与方法1.一般资料:本组93例,其中男63例,女30例,年龄32~76岁,平均56.8岁,有明确外伤史73例,否认外伤史17     

锥颅引流术治疗慢性硬膜下血肿14例分析

对象与方法我院自2003年7月～2004年8月在CT下定位．应用YL—1型一次性颅内血肿粉碎穿刺针治疗慢性硬膜下血肿14例，其中男11例，女3例；年龄7～79岁，平均54岁。有明确外伤史10例；头痛、呕吐11例，精神异常、智能障碍6例，偏瘫9例，言语障碍2例．抽搐2例。CT示血肿位于一侧额颞顶部11例，双侧额颞顶枕部3例：血肿量40～180ml，平均70ml：低密度9例，等密度4例，混杂密度1例。病程20d～3个月。     

改良交叉冲洗单孔引流术治疗慢性硬膜下血肿的疗效

目的 比较交叉冲洗单孔引流术和纯单孔引流术治疗慢性硬膜下血肿（CSDH）的疗效。方法 冋顾性分析2009年8月至2019年8月收治的116例CSDH的临床资料。62例采用交叉冲洗单孔引流术治疗（观察组）,54例采用纯单孔引流术治疗（对照组）。结果 观察组血肿清除率[（95.8±3.2）%]明显高于对照组[（73.6±2.3）%;P<0.05]。观察组术后并发症发生率（6.5%,4/62）明显低于对照组（18.5%,10/54;P<0.05）。观察组术后3个月复发率（3.2%,2/62）明显低于对照组（11.1%,6/54;P<0.05）。结论 与单纯单孔引流术相比,改良交叉冲洗单孔引流术具有血肿清除率高、术后复发率低、并发症率少的优势。     

钻孔引流术治疗中青年慢性硬膜下血肿60例

目的探讨手术治疗中青年慢性硬膜下血肿的近期疗效。方法对60例中青年慢性硬膜下血肿患者采用钻单孔冲洗引流手术。结果60例患者均顺利手术,术后48～72h复查头颅CT示血肿引流干净。术后临床症状均有不同程度改善;均未发生颅内感染、张力性气颅及舾实质损伤等并发症。全部患者术后3月复查头颅cT示血肿全部吸收：随访1年未见复发。结论中青年慢性硬膜下血肿一旦确诊且存在颅内压增高症状,应积极施行手术治疗。     

钻孔引流术治疗慢性硬膜下血肿45例临床分析

目的 探讨慢性硬膜下血肿(CSDH)的临床特征及治疗方法。方法 回顾性分析45例CSDH，就其临床表现、影像学检查、发病机制及治疗结果进行临床分析。结果 对所有病人均行钻孔引流术治疗，CSDH临床症状不典型，积极治疗治愈率达100％。结论 钻孔引流术(BHID)是目前治疗CDSH的首选方法，应尽量避免并发症的产生。     

改良钻孔引流术治疗慢性硬膜下血肿40例分析

目的 介绍一种改良钻孔引流术(BHID)治疗慢性硬膜下血肿(CSDH),减少术后并发症的发生。方法 采用高位单孔钻颅,扩大硬脑膜切口,硅胶管前端置入血肿腔后极低处,然后注水使水流由低处向高处涌泉式冲洗,术后利用虹吸作用从后极低处进行引流。将80例CSDH病人随机分成两组,各40例,分别采用传统和改良方法钻孔引流治疗。对两组病人术后并 发症进行比较性研究。结果 传统组血肿复发8例,继发颅内血肿5例,颅内积气18例,张力性气颅6例,死亡1例;改良组血肿复发1例,继发颅内血肿1例,颅内积气3例(P<0.05),张力性气颅为0,全部治愈出院。结论 这种改良钻孔引流术,治愈率高,并发症少,是对传统钻孔引流术的有益改进。     

单孔引流术治疗慢性硬膜下血肿98例体会

目的探讨单孔引流术治疗慢性硬膜下血肿的疗效及注意事项。方法自2001年10月至2009年6月共收治慢性硬膜下血肿患者98例,均采用单孔引流术治疗。结果治愈94例,复发4例。结论单孔引流术治疗慢性硬膜下血肿,术后并发症少,复发率低,是安全可靠的治疗方法。     

慢性硬膜下血肿钻孔引流术后并发症临床分析

慢性硬膜下血肿（chronicsubduralhematoma,CSDH）为神经外科常见病,颅骨钻孔引流术（burr—holeirrigationanddrainage,BHID）是治疗CSDH常用且有效的方法,但术后并发症却不少见。现将我院1998年1月至2008年4月行BHID术后17例并发症进行回顾性分析,报道如下：     

钻孔引流术治疗慢性硬膜下血肿90例

目的 总结钻孔引流术治疗慢性硬膜下血肿的临床治疗经验。方法 对90例纳入2009年版慢性硬膜下血肿临床路径管理的病人临床资料进行回顾性分析。结果 90例病人中88例顺利完成临床路径,2例因钻孔引流术后继发急性颅内出血行开颅手术而退出临床路径;所有病例随访至少3个月,89例恢复良好,无神经功能障碍;1例昏迷、偏瘫;无复发病例。结论 钻孔引流术治疗慢性硬膜下血肿具有操作简便、手术时间短、术后易于管理、疗效满意、适合纳入临床路径管理的特点。     

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。     

单孔双管闭式引流治疗慢性硬膜下血肿

目的 探讨单孔双管闭式引流治疗慢性硬膜下血肿(CSDH)的临床治疗效果.方法 慢性硬膜下血肿患者随机按单孔单管额部引流组,单孔单管顶枕部引流组和单孔双管引流组,各选取30 例.分析其临床资料和影像学资料.结果 单孔双管引流组中线恢复好于其它二组(P ＜ 0.01),颅内积气和残留液体量三组比较均有显著差异(P ＜0.0...     

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.     

Twist drill craniostomy with closed drainage for chronic subdural haematoma in the elderly: an effective method

OBJECTIVE: Chronic subdural haematoma is a disease of the elderly and surgery in these patients carries a much higher risk. The common surgical procedures for chronic subdural haematoma include twist drill craniostomy, burr hole evacuation or craniotomy. The aim of this study was to analyse the results of twist drill craniostomy with drainage in elderly patients with chronic subdural haematoma. METHODS: Forty-two elderly patients (>65 years) with radiologically proven chronic subdural haematoma were analysed. All the patients underwent twist drill craniostomy and continuous drainage of the haematoma under local anaesthesia and total intravenous anaesthesia (TIVA). RESULTS: There were 24 males and 18 females. Headache and cognitive decline was seen in 50% and weakness of limbs in 60% of patients. CT scan was done in all cases. All patients underwent twist drill 2-3cm in front of the parietal eminence under local anaesthesia. The drain was left for 24-72h depending on the drainage. At 1 week, 88% of patients had a good outcome. CONCLUSION: Twist drill craniostomy with drainage under local anaesthesia is a safe and effective procedure for chronic subdural haematoma in the elderly and could be used as the first and only option in these people.     

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。     

Three cases of chronic subdural hematoma with depressive state

The authors described 3 cases of chronic subdural hematoma (CSDH) with a depressive state. There were no abnormal findings from general and neurological examinations. Computed tomographic (CT) brain scans revealed sickle-shaped low density areas in the bilateral frontal lobes. Two of the 3 cases had not had episodes of head contusion, and it was not until the CT brain scanning that they were found to have CSDH. Evacuation of the hematomas was not considered suitable and the depressive state of these 2 cases was improved by antidepressants. The remaining case seemed to have become depressive because of failure in business. After the head contusion, his depressive state gradually became more severe. A neurosurgical operation was carried out to evacuate the hematoma. CSDH seemed to aggravate his depressive state. These 3 cases show that CSDH located in the bilateral frontal lobes may cause and/or influence affective disorder.     

慢性硬膜下血肿钻孔引流术后硬膜下脓肿形成的治疗

目的慢性硬膜下血肿术后并发硬膜下脓肿极为罕见,治疗方式多为再次置管引流,而选择开颅治疗极少,本文将对其开颅治疗进行讨论。方法回顾报道开颅手术治疗的两例慢性硬膜下血肿钻孔引流术后并发硬膜下脓肿的病例。结果两例病人预后均较好,未残留明显的神经系统受损体征。结论硬膜下脓肿术前的影像学评估十分重要,手术方式是选择再次钻孔引流还是开颅手术需依据术前影像学特征来合理选择,静脉应用敏感抗生素一定要足量、全程。