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中华神经创伤外科电子杂志

中华神经创伤外科电子杂志 ›› 2016, Vol. 02 ›› Issue (02) : 78 -82. doi: 10.3877/cma.j.issn.2095-9141.2016.02.004

所属专题： 文献；

临床研究

负压抽吸冲洗在慢性硬膜下血肿术后早期脑复位中的作用
贺绪智1, 许民辉1,†(), 徐伦山1, 张云东1, 沈光建1, 王旭辉1, 王昊1, 任明亮1, 杨华江1, 张溢华1, 梁鸿1, 易良1, 曾实1   
  1. 1. 400016　重庆，第三军医大学第三附属医院神经外科
  • 收稿日期:2016-02-13 出版日期:2016-04-15
  • 通信作者: 许民辉

Effect of close-conditioned aspiration and irrigation on early postoperative brain reposition in patients with chronic subdural hematoma

Xuzhi He1, Minhui Xu1,†(), Lunshan Xu1, Yundong Zhang1, Guangjian Shen1, Xuhui Wang1, Hao Wang1, Minliang Ren1, Huajiang Yang1, Yihua Zhang1, Hong Liang1, Liang Yi1, Shi Zeng1   

  1. 1. Department of Neurosurgery, The Third Affiliated Hospital of The Third Military Medical University, Chongqing 400016, China
  • Received:2016-02-13 Published:2016-04-15
  • Corresponding author: Minhui Xu
  • About author:
    Corresponding author: Xu Minhui, Email:
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贺绪智, 许民辉, 徐伦山, 张云东, 沈光建, 王旭辉, 王昊, 任明亮, 杨华江, 张溢华, 梁鸿, 易良, 曾实. 负压抽吸冲洗在慢性硬膜下血肿术后早期脑复位中的作用[J]. 中华神经创伤外科电子杂志, 2016, 02(02): 78-82.

Xuzhi He, Minhui Xu, Lunshan Xu, Yundong Zhang, Guangjian Shen, Xuhui Wang, Hao Wang, Minliang Ren, Huajiang Yang, Yihua Zhang, Hong Liang, Liang Yi, Shi Zeng. Effect of close-conditioned aspiration and irrigation on early postoperative brain reposition in patients with chronic subdural hematoma[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2016, 02(02): 78-82.

目的

分析探讨负压抽吸冲洗在慢性硬膜下血肿术后早期脑复位中的作用。

方法

回顾性分析第三军医大学第三附属医院神经外科自2009年7月至2015年7月收治的287例慢性硬膜下血肿患者的临床资料，每例均行颅骨钻单孔，术中开放冲洗78例，闭合等量置换冲洗94例，负压抽吸冲洗115例，术后均置管闭合引流1~3 d，平卧致引流管拔除。全部病例均在术后24~72 h内复查头颅CT 1~2次，记录术后脑复位较好1次CT所示残腔最大厚度占术前血肿腔最大厚度的比值(脑膨胀率)，分别计算开放冲洗组、闭合等量置换冲洗组和负压抽吸冲洗组所得脑膨胀率的标准差。记录所有病例术后早期(≤7 d)的并发症，包括出血、癫痫和感染，术后晚期(≥3个月)并发症，包括硬膜下积液和复发血肿。采用SPSS15.0统计软件对各组标准差进行方差分析，各组临床资料构成比进行χ2检验。

结果

各组冲洗方法术后脑膨胀率差异有统计学意义(P<0.05)。各组临床资料构成比的差异无统计学意义(P>0.05)。各组病例出血、癫痫、感染等早期(≤7 d)并发症的差异无统计学意义(P>0.05)。

结论

针对术后早期(≤72 h)脑复位来讲，术中负压抽吸冲洗优于闭合等量置换冲洗，闭合等量置换冲洗优于开放冲洗。负压抽吸冲洗方法治疗慢性硬膜下血肿是有效、安全的。

关键词: 慢性硬膜下血肿, 脑复位, 负压抽吸冲洗
Objective

To study the efficiency of close-conditioned aspiration and irrigation in early postoperative brain reposition in patients with chronic subdural hematoma(CSDH).

Methods

Retrospective analysis has been applied to 287 CSDH cases treated from July 2009 to July 2015 in the third affiliated hospital of the third military medical university, with burr-hole irrigation and closed-system drainage. During operation, different irrigation had been used: Group A (78 cases) under open condition, Group B(94 cases)with close-conditioned equivalent replacement and Group C (115 cases) with close-conditioned aspiration and irrigation; and postoperative tubes were planted for closed-system drainage, with supination for 1 to 3 days till the extraction. Postoperative CT were all required by 1~2 times within 24~72 h, aiming to get brain expansion ratio between postoperative residual cavity and pre-operative hematoma cavity, based on the best post-operative brain reposition indicated by CT. Mean value of brain expansion ratios were calculated in Group A, B and C. Postoperative complications were recorded at the early(≤7 d) and late (≥3 months) postoperative stages, with bleeding, epilepsy and infection in the early, and subdural fluid collection and hematoma recurrence in the late. SPSS15.0 statistics was applied to every mean value inanalysis of variance, and χ2 test was performed to analyze clinical data.

Results

Postoperative brain expansion ratios are statistically significant(P<0.05) but clinical data is not (P>0.05),nor the early postoperative complications (P>0.05).

Conclusion

As for the early brain reposition(≤72 h), close-conditioned aspiration and irrigation is more advisable in operation than close-conditioned equivalent replacement which is more efficient than open-conditioned irrigation, because of its security and efficiency to CSDH.

Key words: Chronic subdural hematoma, Brain reposition, Close-conditioned aspiration and irrigation
表1 A、B、C三组病例各临床资料构成比
? 临床资料 A组(78) B组(94) C组(115) P值
性别 男 64 77 94 0.998 4
女 14 17 21
? >70岁 32 39 47 ?
年龄 50~70岁 36 44 54 0.999 6
? <50岁 10 11 14 ?
? <1.5 15 19 23 ?
术前血肿最大厚度(cm) 1.5~2.0 17 20 24 1
2.1~2.5 24 29 36
? >2.5 22 26 32 ?
? <0.5 33 39 48 ?
术前中线移位(cm) 0.5~1.0 17 21 25 0.989 4
? >1.0 28 34 42 ?
术前应用抗凝药物 有 5 6 8 0.982 6
无 73 88 107
? <2个月 16 19 23 ?
受伤距离手术时间 2~3个月 14 17 21 1.0
>3个月 11 14 17
? 无确切外伤史 37 44 54 ?
表2 A、B、C三组脑膨胀率的比较(±s)
组别 例数 膨胀率 F值 P值
A组 78 0.47±0.12 ? ?
B组 94 0.35±0.12 64.54 0.000
C组 115 0.27±0.13 ? ?
表3 A、B、C三组病例早期(≤7 d)和晚期(≥3个月)并发症比较
组别 例数 术后早期并发症(≤7 d) 术后晚期并发症（≥3个月）
发生出血例数（率） 发生癫痫例数（率） 发生颅内感染例数（率） 发生硬膜下积液例数（率） 发生血肿复发例数（率）
A组 78 3(3.8%) 4(5.1%) 2(2.6%) - -
B组 94 3(3.2%) 5(5.1%) 1(1.1%) - -
C组 115 1(0.9%) 3(2.6) 0(0%) 1 1
χ2 ? 1.874 0.857 2.916 - -
P ? 0.171 0.355 0.088 - -
[1]
Kwan MC,Sun DT,Poon WS. Types of postoperative drainage for chronic subdural hematoma: to do it on the table or under?[J]. World Neurosurg, 2012, 77(1): 51-52.
[2]
Iliescu IA. Current diagnosis and treatment of chronic subdural haematomas[J]. J Med Life, 2015, 8(3): 278-284.
[3]
Kolias AG,Chari A,Santarius T, et al. Chronic subdural haematoma: modern management and emerging therapies[J]. Nat Rev Neurol, 2014, 10(10): 570-578.
[4]
Pahatouridis D,Alexiou GA,Fotakopoulos G, et al. Chronic subdural haematomas: a comparative study of an enlarged single burr hole versus double burr hole drainage[J]. Neurosurg Rev, 2013, 36(1): 151-154.
[5]
Takayama M,Terui K,Oiwa Y. Retrospective statistical analysis of clinical factors of recurrence in chronic subdural hematoma: correlation between univariate and multivariate analysis[J]. No Shinkei Geka, 2012, 40(10): 871-876.
[6]
Oishi M,Toyama M,Tamatani S, et al. Clinical factors of recurrentchronic subdural hematoma[J]. Neurol Med Chir (Tokyo), 2001, 41(8): 382-386.
[7]
Ro HW,Park SK,Jang DK, et al. Preoperative predictive factors for surgical and functional outcomes in chronic subdural hematoma[J]. Acta Neurochir (Wien), 2016, 158(1): 135-139.
[8]
Choudhury AR. Avoidable factors that contribute to complications in the surgical treatment of chronic subdural haematoma[J]. Acta Neurochir (Wien), 1994, 129(1-2): 15-19.
[9]
Aoki N. A new therapeutic method for chronic subdural haematoma in adults: replacement of the haematoma with oxygen via percutaneous subdural tapping[J]. Surg Neurol, 1992, 38(4): 253-256.
[10]
Kubo S,Takimoto H,Nakata H, et al. Carbon dioxide insufflation for chronic subdural haematoma: a simple addition to burr-hole irrigation and closed-system drainage[J]. Br J Neurosurg, 2003, 17(6): 547-550.
[11]
Grisoli F,Graziani N,Peragut JC, et al. Perioperative lumber injection of Ringer’s lactate solution in chronic subdural haematoma: a series of 100 cases[J]. Neurosurgery, 1988, 23(5): 616-621.
[12]
Weigel R,Schlickum L,Weisser G, et al. Treatment concept of chronic subdural haematoma according to an algorithm using evidence-based medicine-derived key factors: A prospective controlled study[J]. Br J Neurosurg, 2015, 29(4): 538-543.
[13]
Xu C,Chen S,Yuan L, et al. Burr-hole irrigation with closed-system drainage for the treatment of chronic subdural hematoma: a meta-analysis[J]. Neurol Med Chir (Tokyo), 2015, 17.
[14]
Ihab Z. Pneumocephalus after surgical evacuation of chronic subdural hematoma: Is it a serious complication?[J]. Asian J Neurosurg, 2012, 7(2): 66-74.
[15]
Tosaka M,Sakamoto K,Watanabe S, et al. Critical classification of craniostomy for chronic subdural hematoma; safer technique for hematomaaspiration[J]. Neurol Med Chir (Tokyo), 2013, 53(4): 273-278.
[16]
Heula AL,Ohlmeier S,Sajanti J, et al. Characterization of chronic subdural hematomafluid proteome[J]. Neurosurgery, 2013, 73(2): 317-331.
[17]
Mori K,Maeda M. Surgical treatment of chronic subdural hematoma in 500 consecutive cases: clinical characteristics, surgical outcome, complications, and recurrence rate[J]. Neurol Med Chir (Tokyo), 2001, 41(8): 371-381.
[18]
Dinc C,Iplikcioglu AC,Bikmaz K, et al. Intracerebral haemor rhage occurring at remote site following evacuation of chronic subdural haematoma[J]. Acta Neurochir (Wien), 2008, 150(5): 497-499.
[19]
Rusconi A,Sangiorgi S,Bifone L, et al. Infrequent hemorrhagic complications following surgical drainage of chronic subdural hematomas[J]. J Korean Neurosurg Soc, 2015, 57(5): 379-385.
[20]
Grisoli F,Graziani N,Peragut JC, et al. Perioperative lumbar injection of Ringer’slactate solution in chronic subdural hematomas: a series of100 cases[J]. Neurosurgery, 1988, 23(5): 616-621.
[21]
Hirakawa K,Hashizume K,Fuchinoue T, et al. Statistical analysis of chronic subduralhematoma in 309 adult cases[J]. Neurol Med Chi (Tokyo), 1972, 12(0): 71-83.
[22]
Battaglia F,Lubrano V,Ribeiro-Filho T, et al. Incidence and clinical impact of seizures after surgery for chronic subdural haematoma[J]. Neurochirurgie, 2012, 58(4): 230-234.
[23]
Chen CW,Kuo JR,Lin HJ, et al. Early post-operative seizures after burr-hole drainage for chronic subdural hematoma:correlation with brain CT findings[J]. J Clin Neurosci, 2004, 11(7): 706-709.
[24]
Zumofen D,Regli L,Levivier M, et al. Chronicsubdural hematomas treated by burr hole trepanation and a subperiostal drainage system[J]. Neurosurgery, 2009, 64(6): 1116-1121.
[25]
Smely C,Madlinger A,Scheremet R. Chronic subdural haematoma—a comparison of two different treatment modalities[J]. Acta Neurochir (Wien), 1997, 139(9): 818-825.
[26]
Kuroki T,Katsume M,Harada N, et al. Strict closed-system drainage for treating chronic subdural haematoma[J]. Acta Neurochir (Wien), 2001, 143(10): 1041-1044.
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