【摘要】 目的:探讨慢性硬脑膜下血肿手术治疗的最佳术式策略及方法选择。方法:对330例390个(单侧血肿270例,双侧血肿60例)慢性硬脑膜下血肿的临床表现及手术方式,术后复查CT或MRI随访结果进行临床分析。结果:单侧血肿钻一孔引流224例,钻二孔引流35例,双侧血肿两侧各钻一孔引流49例,双侧血肿两侧各钻二孔引流11例,11例行开颅血清除包膜切除术,术后临床症状明显改善327例,无变化3例,其中1例术后并发肺部感炎死亡,另1例突发心肌梗塞死亡,术后第一天例行头颅CT检查,血肿腔明显变小,大部分病例脑组织复位,硬脑膜下有少量积液和气体,1月至3个月随访复查CT165例,其中示有血肿复发再次手术3例,163例示脑组织复位,临床恢复良好。结论:慢性硬脑膜下血肿早期临床症状不典型,及时进行CT或MRI检查明确诊断,手术治疗效果显著,但慢性硬脑膜下血肿常见老年人,常合并其他疾病,手术方式及麻醉选择对疗效有一定的影响。更多还原

【Abstract】 Objective: To explore the best operative strategy and methods for chronic subdural hematoma. Methods: To study the clinical manifestations and operative methods about chronic subdural hematoma on 330 cases, with 270 cases of unilateral hematoma and 60 cases of bilateral hematoma, analysis the Follow-up using CT orMRI results postoperative. Results: A hole were drilled on 224 cases and two holes were drilled on 35 cases of unilateral hematoma, a hole were drilled on both sides on 49 cases and two holes were drilled on both sides on11 cases of bilateral hematoma. Clinical symptoms significantly improved with craniotomy blood clearance and coating removal on 327 cases, but had no change on 3 cases, one patient died forpulmonary infection postoperative and one patient died forheart infarction Suddenly. All the patients underwent CT examination at the first day postoperative. Hematoma cavity significantly reduction and brain tissue reposition were found, fluidify and pneumatosis existed in subdural on most cases.165 patients underwent CT examination from 1 month to 3 months in follow-up period, brain tissue reposition and good clinical recovery were found on 163 cases, but reoperation had to do on 3 cases forhematoma recurrence. Conclusion: there were no typical clinical symptoms in the early time of chronic subdural hematoma, CT or MRI examination timely were used to diagnosis, operative treatment had significantly effect. Most chronic subdural hematoma were elderly patients who often associated with other diseases, operative method and anesthesia selection had some influence on therapeutic effect.更多还原