高位钻孔和偏颅骨侧置管引流治疗老年人慢性硬膜下血肿

目的探讨老年人慢性硬膜下血肿（chronic subdural hematoma,CSDH）的手术方法,以减少术后严重并发症的出现。方法78例老年CSDH患者（A组）行血肿高位钻孔、血肿外1/3置管冲洗和外引流治疗;145例老年CSDH患者（B组）行血肿中央钻孔外引流治疗,两组病例行对照分析。结果A组78例,治愈76例（97.4%）,好转2例（2.6%）。术后无张力性气颅发生,脑脊液漏2例（2.6%）,癫痫发作3例（3.8%）,精神障碍1例（1.3%）;B组145例,治愈132例（91.0%）,好转9例（6.2%）,死亡4例（2.76%）;术后发生颅内血肿6例（4.1%）,血肿复发5例（3.4%）,大量颅内积气并张力性气颅12例（8.3%）,脑脊液漏5例（3.4%）,癫痫5例（3.4%）,精神障碍3例（2.1%）,颅内感染1例（0.7%）。两组患者治愈好转率差异有统计学意义（P〈0.05）。结论老年人CSDH患者行血肿高位钻孔、血肿外1/3置管冲洗和外引流治疗,手术效果好,术后严重并发症少,值得临床推广使用。

High drilling and drain pipe placed near skull 1/3 of hematoma in treatment of elderly chronic subdural hematoma

Objective To investigate the cause and countermeasure for postoperative complications of trepanation and drainage of chronic subdural hematoma(CSDH).Methods In the clinical materials of group A,78 cases were treated by drilling on highest point of hematoma,draining CSDH with pipe near skull 1/3 of hematoma.And in group B,145 cases were treated by drilling and draining CSDH on center of hematoma.Two groups materials were analyzed comparatively.Results Of group A,there were 76 cases cured(97.4%) and 2 cases improved(2.6%).There were some complications ,2 cases with leakage of cerebrospinal fluid(2.6%),3 cases epilepsy(3.8%) and 1 case mental disorder(1.3%).Of group B,there were 132 cases cured(91.0%) and 9 cases improved(6.2%) and 4 cases died(2.76 %).Six cases with intracranial hematoma(4.1%),5 cases recurrent subdural hematoma(3.4%),12 cases with intracranial pneumatosis and encephalic press to raise (8.3%),5 cases with leakage of cerebrospinal fluid(3.4%),8 cases with epilepsy(5.5%),3 cases with mental disorder(2.1%) and 1 case with intracranial infection(0.7%).The cure and improvement rates had significant differences between the two groups (P<0.05).Conclusions Drilling on highest point, and draining CSDH with pipe near skull 1/3 of hematoma has comfirmed effect,few complications,worthy to be popularized.