急性硬膜下血肿清除术后迟发性硬膜下积液的诊治

目的 探讨急性硬膜下血肿清除术后硬膜下积液的原因、早期诊断、手术治疗方法和疗效。方法 对急性硬膜下血肿后硬膜下积液29例进行回顾性分析。结果 痊愈14例，占48．7％；轻残5例，占17．2％；重残4例，占13．8％；植物状态3例，占10．3％，死亡3例，占10．3％。引流效果良好，无一例颅内感染。结论 急性硬膜下血肿清除后可能发生硬膜下积液；术后意识无改善或意识好转后又加重、出现颅内压增高征象、神经系统定位体征、减压区膨隆、瞳孔及生命体征改变应予CT检查可明确诊断：积液区颅骨钻孔或减压区小切口置管引流简便易行，有效满意疗效。

Diagnosis and treatment of delayed subdural hydropsy after evacuation of acute subdural hematoma

Objective To investigate the cause, early diagnosis, operative met hod and efficacy of subdural hydropsy after evacuation of acute subdural hematom a.Methods From December 1998 to December 2002,29 cases with postoperative delaye d subdural hydrosy of evacuation of acute subdural hematoma were analyzed retros pectively.Results 14 cases were cured(48 7%).5 cases were mild disability(17 2%) 4 cases were severe disability(13 8%).3 cases were in vegetal status(10 3%).3 cases died(10 3%). No intracranial infection was found.Conclusion Subdu ral hydropsy may occur after evacuation of acute subdural hematoma.If it has no improvement or changed from better to worse,including manifestation of increasin g intracranial pressure and localized sign of nervous system etc,the CT examinat ion should be done to confirm the diagnosis.The skull is drilled in the hydropsy area or a drainage tube is put in the decompressed area using minor incision,wh ich is a simple and effective method.