慢性硬膜下血肿的诊断治疗体会

目的探讨慢性硬膜下血肿的临床特点和治疗体会.方法回顾性分析5年内诊治的103例慢性硬脑膜下血肿,调查其一般资料、临床表现、血肿部位和血肿量以及CT检查,探讨了钻孔冲洗引流及开颅清除血肿的疗效.结果该组病例50岁以上占67.0%,中位病程4.5周,头痛、恶心、呕吐以及视乳头水肿仍是最常见表现.头颅CT检查提示大多数慢性硬脑膜血肿的CT密度较低,和引流的液态血性液体相一致.92例采用钻孔冲洗引流方法,其中85例愈合过程平稳,另7例予以再次钻孔引流或开颅清除血肿;其余11例采用开颅血肿清除术,术后9例恢复平稳,另2例遗有轻偏瘫和不完全性运动失语.结论经颅钻孔冲洗引流被认为是治疗本病的最佳方法,部分液化不佳的多房分隔型血肿仍需要开颅清除血肿.

The experience of Diagnosis and Treatment about Chronic Subdural Hematoma

Objective To explore the experience of diagnosis and treatment about chronic subdural hematoma. Methods There were 103 cases of chronic subdural hematoma during recent 5 years whoses data of clinical manifestation, the position and volume of hematoma, and CT-scan were analysed retrospectively, and the therapeutic effects were compared between drainage through drilling and craniotomy. Results The proportion of more than 50 years old was67.0%. The middle course of disease was 4.5 weeks, and the most common manifestations were headache, nausea, vomiting and optic disc. edema. The cranium CT-scan showed that most cases of CT density were relatively low, which was in according with the liquid state of drainage. There were 92 cases who had hematoma rinsed and drained through drilling of cranium, among which 85 cases recovered smaothly and 7 cases had a second drilling or craniotomy. There were still 11 cases who had cranintomy, among which 9 cases recovered smoothly and 2 cases existed hemipamsis and partial motor aphasia. Conclusions The preferred way for chronic subdural hematoma is rinsing and drainage through drilling of cranium, but craniotomy is prefered in cases that the hematoma is high-density or multiple chambers by CT-scan.