慢性硬脑膜下血肿手术技巧探讨

目的 探讨慢性硬脑膜下血肿(CSDH)手术技巧.方法 回顾性分析250例CSDH患者的临床资料,包括一般情况、手术方法及预后情况等.结果 CSDH患者中50岁以上的老年患者202例,明确外伤史176例.单纯钻孔引流手术治疗的25例中产生气颅10例,其中6例为张力性气颅,5例血肿复发,均行二次手术治愈,其余患者亦治愈.钻孔冲洗加置管闭式引流手术治疗207例患者,无一例产生气颅和颅内感染,20例术后复发二次手术治愈,1例置管插入脑实质内导致脑挫裂伤,给予积极救治后好转.另18例采取骨瓣开颅术、血肿清除加包膜切除均治愈.结论 CSDH多发于50岁以上,大多数发病与头部外伤相关.钻孔冲洗加置管闭式引流手术具有操作简便、安全、创伤小以及治愈率高等优点,掌握其手术技巧包括术中彻底冲洗、置管引流以及对脑组织的保护是手术成功的关键.

Approach of operative technique in treatment of chronic subdural hematoma

Objective To approach operative technique for chronic sub, dural hematoma (CSDH).Method The clinical information including general state of health, operative technique and prognosis of the 250 cases with CSDH were retrospectively analyzed. Results Within the 250 cases, 202 were old people with age over 50 and 176 had definite trauma history. In 25 cases treated by burr hole and drainage, 5 cases who had hematoma recurrence and 10 cases who had pneumocephalus, among whom, 6 had tensional pneumoeephalus, were all cured by second operation while the rest got cured. In 207 cases treated by burr hole, douche and drainage, no pneumocephalus or intracranial infection occurred. Twenty of them relapsed and were cured by second operation. Cerebral contusion eccurred in 1 case for pipe was inserted into the brain tissue by mistake, but it got better after active therapy. The other 18 cases were all cured through eraniotomy,hematomas removal as well as envelope excision. Conclusions CSDH is common in the old with age over 50 and it has relationship with head injury,mostly. The single hole trepanation, douche and drainage is simple, safe ,with minimal trauma and high cure rate. To master the operative technique including douching thoroughly, drainage through a pipe and brain protection is very important to the success of the operation.