老年慢性硬膜下血肿的微创手术治疗与围手术期处理

目的探讨老年人慢性硬膜下血肿微创手术治疗的疗效和围手术期处理。方法针对老年患者特点进行充分的准备。局麻下使用微创单孔和双孔钻颅,导管冲洗引流,单导管放置引流治疗54例慢性硬膜下血肿。日引流量〈15ml或引流液清淡时拔除引流管。结果51例术后原有的症状体征消失,复查CT血肿腔闭合良好,原有血肿腔厚度在3ml以下。随访1个月至2年,无颅内感染、无癫痫及其他神经功能障碍。结论对于伴有多脏器疾病的老年慢性硬膜下血肿患者采用微创手术术后恢复良好。微创单孔或双孔钻颅,术中持续冲洗、术后闭式引流是一种简便、安全的手术方法。

Microinvasive operation and perioperative management on elderly patients with chronic subdural hematomas

Objective To investigate the feature and principle of perioperative management of chronic subdural hematoma in elderly patients with chronic subdural hematomas by microinvasive operation. Methods With sufficient preoperotive preparation, fifty＇four patients were treated initially with microinvasive single or double trepanation hole for evacuation of the hematoma followed by irrigation and drainage. Whenever the volume of the hematoma drainage decreased below 15 ml, the tubes were pull out. Results The symptoms and signs disappeared after operation in 51 cases. Postoperative CT scan indicated the collapse of hematoma cavity. The hematoma breadth decreased to less than 3 ram. Postoperatively, 51 patients returned to their condition before operation. No meningitis, epilepsy and other neurological dysfunction were seen after 1 month to 2 years follow-up. Conclusion Single or double trepanation holes for evacuation of the hematoma followed by constant closed drainage is a good choice for elderly patients under local anesthesia. The elderly patients recover very well in the postoperative period. The method is suitable for chronic subdural hematoma patients with multiple organ dysfunctions. It is a safe and microinvasive operation.