摘要
目的探讨慢性硬膜下血肿(CSDH)术后复发的相关危险因素及其防治。方法回顾性分析2000年1月至2011年2月收治的187例CSDH患者的临床资料,包括临床特点、影像学表现、手术方法、手术结果及其与复发的关系。本组187例CSDH患者中,179例行钻孔引流术治疗,8例行开颅血肿清除术治疗。入院时和出院时按Bender分级评估患者的神经功能。结果出院时Bender分级0～Ⅰ级168例(89.8%),Ⅱ～Ⅳ级19例(10.2%);入院时0～Ⅰ级98例(52.4%),Ⅱ～Ⅳ级89例(47.6%),入院时与出院时Bender0～Ⅰ级和Ⅱ～Ⅳ级患者百分率均差异显著(P<0.05)。本组术后6个月内硬膜下血肿复发32例(17.1%),并发症发率为56.1%。血肿复发者的术前凝血功能障碍率、CT图像上血肿混杂密度的发生率和脑中线移位≥10mm发生率均明显高于无血肿复发者(P<0.05)。结论本文提示,与慢性硬膜下血肿复发有关的因素包括术前凝血功能障碍、CT图像上血肿呈现混杂密度和脑中线移位≥10mm。综合治疗可减少慢性硬膜下血肿的术后复发。
Objective To explore the factors related to postoperative recurrence of chronic subdural hematomas（CSDHs） and theirp revention and treatment in the patients with brain injury.Methods The clinical data of 187 brain injury patients with CSDHs whou nderwent surgery in our hospital from January 2000 to February,2011 were analyzed retrospectively,including the clinical features,i maging manifestation and operative method and outcomes.Of 187 patients with CSDHs,179 were treated by burr-hole and drainagea nd 8 by craniotomy and evacuation of CSDHs.The cause of recurrence of CSDHs in 32 patients was analyzed.The neurological functionw as assessed by Bender grade before and after the surgery.Results The percentage of the patients with Bender grade 0～Ⅰafter thes urgery（89.8%） was significantly higher than that（52.4%） before the surgery（P0.05） .The recurrent rate of CSDHs was 17.1%within 6m onths after the surgery.The rate of the postoperative complications was 56.1%.The coagulation dysfunction rate,the rate ofi nhomogeneous density hematoma on CT image and the rate of cerebral midline shift≥10 mm were significantly higher in the patientsw ith recurrent of CSDHs than those in the patients without recurrent of CSDHs（P0.05） .Conclusions It is suggested that the factorsr elated to the recurrent of CSDHs include the preoperative coagulation dysfunction,inhomogeneous density of hematomas on CT imagea nd cerebral midline shift≥10 mm.The combined treatment can reduce the recurrence rate of hematomas in the patients with braini njury.
出处
《中国临床神经外科杂志》
2011年第11期670-672,共3页
Chinese Journal of Clinical Neurosurgery
关键词
慢性硬膜下血肿
术后复发
引流术
Brain injury
Chronic subdural hematoma
Recurrence
Surgery
Drainage
