钻孔位置在慢性硬膜下血肿钻孔冲洗引流术中的作用

钻孔冲洗引流术是目前普遍认可的治疗慢性硬膜下血肿(chronic subdural hematoma，CSDH)的首选方法，具有简单有效、损伤小等优点，但也可发生多种并发症。我院1992年～2003年应用钻孔冲洗引流治疗CSDH 122例，死亡1例，出现急性硬膜外血肿1例，余120例无并发症治愈。作者认为术中适宜调整钻孔位置是预防CSDH钻孔冲洗引流术后并发症的关键。     

Trepanation and surgical infection in the 18th century

Background

It is widely believed that trepanation prior to modern surgical hygiene was dangerous because of surgical infection, especially in the hospital. There has been a wide variability in the success and risks of different historical studies

Purpose

To obtain a more accurate assessment of the risks of post-operative infection following 18th-century cranial trauma and to note what factors were of prognostic significance.

Material and methods

Seven 18th-century texts on head injury are reviewed and analyzed.

Results

Infection was the commonest cause of death (in over 60 % of patients) in five series but not in the other two. Hospital admission did not appear to be a major factor influencing mortality from infection. Delayed infection was the indication for patient referral and trepanation in more than two patients in two series. In one series, the patients were helped by the procedure, in the other they were not. The reasons for the difference are discussed. The most striking finding was that patients treated in rural areas had a much better prognosis.

Conclusions

The risks of suffering a surgical infection following head injury and trepanation are multifactorial. Admission to hospital seems to have been less risky than has been previously thought. It seems that the greatest risk factor for a lethal infection for these patients was living in an urban environment.     

Zur Indication der Trepanation bei Gehirnblutung im Verlaufe des Keuchhustens

Ohne Zusammenfassung     

What is a sentinel node and what is a false-negative sentinel node?

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