慢性硬膜下血肿31例钻孔引流术治疗的体会

目的 对31例慢性硬膜下血肿的钻孔引流治疗及并发症进行研究和探讨。方法 31例慢性硬膜下血肿均行钻孔引流术。结果 治愈27例（87．1％），无一例死亡，有5例大量颅内积气（含1例张力性气颅），血肿复发1例，急性硬膜外血肿2例，脑内血肿1例，脑脊液漏3例，癫痫发作或精神障碍4例。122k除张力性气颅、血肿复发及1例急性硬膜外血肿再次手术外，其他病人在7～21天治愈或好转出院。结论 钻孔引流术是对慢性硬膜下血肿的简单有效的治疗方法，但我们必须重视钻孔引流术的并发痒．并积极做好预防及治疗工作．以至于最大限度地提高慢性硬膜下血肿的治愈率。     

慢性硬膜下血肿钻孔引流术并发症的防治

慢性硬膜下血肿(CSDH)主要的治疗方法为钻孔冲洗闭式引流术,其手术简单,创伤小,疗效可靠,但仍出现一些严重的并发症.本文近年来用这一方法治疗CDSH79例,发生各种并发症10例.现总结分析如下.     

慢性硬膜下血肿钻孔引流210例分析

慢性硬膜下血肿(CSDH)在颅脑损伤中并不少见.本院自1987年8月至2002年12月期间,共收治(CSDH)病人210例,占同期收治颅脑损伤病人的4%左右.现报告如下.     

颅骨钻孔冲洗引流术治疗慢性硬膜下血肿82例

目的:探讨颅骨钻孔冲洗引流术治疗慢性硬膜下血肿的临床疗效。方法:82例患者均行颅骨钻孔冲洗引流术。结果:82例患者均治愈,无死亡病例。发生颅内积气12例,脑脊液漏8例,血肿复发1例,癫痫1例,均治愈。结论:该术式方法简单,损伤小,疗效显著,是治疗慢性硬膜下血肿的首选方法。     

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。     

慢性硬膜下血肿钻孔引流术后并发症的护理

慢性硬膜下血肿（CSDH）为受伤后3周以上出现的硬膜下积血，约占颅内血肿的10％．为硬膜下血肿的25％，高龄者好发。钻孔引流术（BHID）是治疗慢性硬膜下血肿的常用方法。操作简单、治愈率高．但也能引起一些并发症，甚至危及生命。本院从1999年3月至2005年10月行慢性硬膜下血肿钻孔引流术共42例．发生并发症10例，现就其观察及护理进行探讨。     

微创钻孔引流术治疗慢性硬膜下血肿42例

【摘要】目的：探讨微创钻孔引流术治疗慢性硬膜下血肿的手术效果。方法：回顾性分析自2006年至2011年间在本院住院手术治疗的42例老年慢性硬膜下血肿患者,所有患者均行微创钻孔引流术治疗,术后行闭式引流,2～5天后拔管,观察治疗效果。结果：40例患者拔管前复查头颅CT显示血肿已大部分清除,临床症状消失或明显改善,2例引流无效改为开颅血肿清除手术,有2例术后血肿复发,4例出现颅内积气。结论：微创钻孔引流术治疗慢性硬膜下血肿疗效确切,具有创伤小、安全可靠、并发症少等优点,是目前治疗该类患者的首选方法。     

硬膜下血肿钻孔引流术后护理体会

目的总结慢性硬膜下血肿行硬膜下血肿钻孔引流术后的护理体会。方法对56接受硬膜下血肿钻孔引流术的慢性硬膜下血肿患者,行密切病情观察、引流管护理、功能锻炼等精心护理。结果本组56患者临床症状均明显缓解,术后未出现、压疮、静脉血栓形成、感染等并发症。住院时间11~16 d,均康复出院。结论做好硬膜下血肿钻孔引流术后的各项护理措施,可降低并发症发生率,促进患者功能恢复,减少后遗症。     

慢性硬膜下血肿全封闭式钻孔引流术的治疗体会

钻孔引流术是目前治疗慢性硬膜下血肿（CSDH）的首选方法犤１犦，但仍有一些并发症影响其临床病程及预后。本院自１９９８年１月至２００１年７月，采用全封闭钻孔引流治疗CSDH患者６２例，明显减少了并发症的发生。现总结如下。资料与方法⒈一般资料：本组男４９例，女１２例；年龄２～６岁，其中６０岁以上３９例，５岁以下３例；有明确头部外伤史５３例；外伤距手术时间１～１１个月。２．症状和体征：头痛或头昏３８例，肢体不同程度偏瘫４１例，意识障碍１２例，智能障碍和精神异常５１例，昏迷伴一侧瞳孔散大２例。⒊CT或MRI扫…     

Burr-hole Irrigation with Closed-system Drainage for the Treatment of Chronic Subdural Hematoma: A Meta-analysis

There is controversy among neurosurgeons regarding whether irrigation or drainage is necessary for achieving a lower revision rate for the treatment of chronic subdural hematoma (CSDH) using burr-hole craniostomy (BHC). Therefore, we performed a meta-analysis of all available published reports. Multiple electronic health databases were searched to identify all studies published between 1989 and June 2012 that compared irrigation and drainage. Data were processed by using Review Manager 5.1.6. Effect sizes are expressed as pooled odds ratio (OR) estimates. Due to heterogeneity between studies, we used the random effect of the inverse variance weighted method to perform the meta-analysis. Thirteen published reports were selected for this meta-analysis. The comprehensive results indicated that there were no statistically significant differences in mortality or complication rates between drainage and no drainage (P > 0.05). Additionally, there were no differences in recurrence between irrigation and no irrigation (P > 0.05). However, the difference between drainage and no drainage in recurrence rate reached statistical significance (P < 0.01). The results from this meta-analysis suggest that burr-hole surgery with closed-system drainage can reduce the recurrence of CSDH; however, irrigation is not necessary for every patient.     

慢性硬膜下血肿引流术后突发大出血3例报告

2002年4月至2004年6月,我院共采用钻孔引流术治疗慢性硬膜下血肿(chronic subdural hematoma, CSDH)36例,其中3例(8.3%)术后突发大出血,由于引流管留置合理,处理及时,预后良好,现报道如下.     

慢性硬膜下血肿病人钻孔引流术后并发症原因分析及护理

对16例慢性硬膜下血肿钻孔引流术后并发症(颅内血肿、癫癎、脑脊液漏等)原因进行分析,提出护理人员必须对钻孔引流术后可能发生的并发症有充分认识,术后严密观察病情;对并发症早发现、早处理,以及时抢救生命.     

Conservative Treatment of Chronic Subdural Hematoma with Gorei-san

Most asymptomatic patients with chronic subdural hematoma (CSDH) are followed conservatively but can require surgical treatment if the hematoma expands. We conducted a retrospective evaluation of the effect of Gorei-san on CSDH. This study included patients treated between April 2013 and March 2015. In total, 289 patients were diagnosed with CSDH and 110 patients received conservative management. Finally, 39 patients who met the requirements were registered. We retrospectively examined the age, gender, medical history, hematoma thickness, clarity of sulci below hematomas, and midline shift of the patients. The primary outcome was the median surgery-free interval, and the secondary results were the rate of CSDH shrinkage and surgery avoidance. A comparison of patient characteristics between the Gorei-san (G) and non-Gorei-san (NG) groups found no significant differences in the percentage of men, average ages, past history, thickness of CSDH (15.0 ± 3.1 mm vs. 15.3 ± 2.6 mm, p = 0.801), or midline shift (2.0 ± 2.7 mm vs. 4.0 ± 5.0 mm, p = 0.230). The median surgery-free interval was significantly different between the G and NG groups [n. r. vs. 41 days (95% CI: 5-79), log-rank p = 0.047]. The CSDH avoidance rate was not significantly different between the two groups (70.0% vs. 34.4%, p = 0.071). Additionally, the CSDH shrinkage rate was significantly different between the two groups (60.0% vs. 10.3%, p = 0.004). This retrospective study demonstrated that CSDH treatment with Gorei-san reduces hematoma significantly more than treatment that does not include Gorei-san.     

Strict Closed-System Drainage for Treating Chronic Subdural Haematoma

Summary. A comparative study chiefly of the recurrence rate of chronic subdural haematoma after two treatment modalities was conducted. Patients were divided into a burr hole strict closed-system drainage group (SCD group; n=56) and a burr hole closed-system drainage with irrigation group (CDI group; n=45). The burr hole strict closed-system drainage involved simply inserting a drainage tube into the haematoma cavity as quickly as possible after minimally incising the haematoma capsule. The introduction of air into the haematoma cavity was prevented, and irrigation was not performed. Symptoms in both groups disappeared soon after surgery, with no postoperative complications. Haematoma recurred in one patient (1.8%) of the SCD group compared with 5 (11.1%) of the CDI group. The rate of recurrence was significantly lower for the SCD than for the CDI group (p<0.05). In 4 of 5 recurrences in the CDI group, the volume of residual intracapsular air was sufficient after initial surgery. These results suggested that postoperative residual intracapsular air is a factor contributing to recurrence. Burr hole strict closed-system drainage is a simple, less invasive procedure with which to treat chronic subdural haematoma and the outcome is excellent. Furthermore, prevention of intracapsular air intrusion during surgery might help prevent recurrence.