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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 ›› 2020, Vol. 06 ›› Issue (04) : 233 -236. doi: 10.3877/cma.j.issn.2095-9141.2020.04.009

所属专题： 文献；

临床研究

一种新型封闭式钻孔引流术治疗慢性硬膜下血肿的临床疗效初步观察
黄新1, 龚凯1, 徐伟东1, 徐裕1, 蒋剑峰1, 薛鑫诚1, 吴晓峰1, 周新民1,†()   
  1. 1. 214400　江苏无锡，江阴市人民医院神经外科
  • 收稿日期:2020-01-16 出版日期:2020-08-15
  • 通信作者: 周新民

Clinical effect of a new closed irrigation and drainage technique for surgical evacuation of chronic subdural haematomas

Xin Huang1, Kai Gong1, Weidong Xu1, Yu Xu1, Jianfeng Jiang1, Xincheng Xue1, Xiaofeng Wu1, Xinmin Zhou1,†()   

  1. 1. Department of Neurourgery, Jiangyin People’s Hospital, Wuxi 214400, China
  • Received:2020-01-16 Published:2020-08-15
  • Corresponding author: Xinmin Zhou
  • About author:
    Corresponding author: Zhou Xinmin, Email:
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黄新, 龚凯, 徐伟东, 徐裕, 蒋剑峰, 薛鑫诚, 吴晓峰, 周新民. 一种新型封闭式钻孔引流术治疗慢性硬膜下血肿的临床疗效初步观察[J]. 中华神经创伤外科电子杂志, 2020, 06(04): 233-236.

Xin Huang, Kai Gong, Weidong Xu, Yu Xu, Jianfeng Jiang, Xincheng Xue, Xiaofeng Wu, Xinmin Zhou. Clinical effect of a new closed irrigation and drainage technique for surgical evacuation of chronic subdural haematomas[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2020, 06(04): 233-236.

目的

观察慢性硬膜下血肿（CSDH）患者行单骨孔封闭冲洗及骨膜下引流术的疗效。

方法

选取江阴市人民医院神经外科自2017年1月至2019年6月收治的CSDH患者106例，分为常规单骨孔钻孔引流术组（常规组）和单骨孔封闭冲洗及骨膜下引流术组（封闭组），对2组患者的手术疗效及并发症进行统计分析。

结果

2组患者的手术疗效比较差异无统计学意义（Z=0.262，P>0.05）；封闭组术后颅内积气量明显低于常规组，差异有统计学意义（Z=3.963，P<0.05）；2组患者术后症状性气颅、脑损伤、切口脑脊液漏、癫痫发作、血肿复发的发生率比较差异无统计学意义（P>0.05）。

结论

单骨孔封闭冲洗及骨膜下引流术治疗CSDH能明显降低术后颅内积气，是一种简单、有效、安全的治疗手段。

关键词: 慢性硬膜下血肿, 封闭式钻孔引流术, 骨膜下引流, 颅内积气
Objective

To observe the clinical effect of single burr-hole irrigation and continuous closed sub-periosteal drainage in patients with chronic subdural hematoma (CSDH).

Methods

A total of 106 patients with CSDH admitted to Department of Neurosurgery, Jiangyin People’s Hospital from January 2017 to June 2019 were divided into the conventional single bone hole drilling and drainage group (conventional group) and the single burr-hole irrigation and continuous closed sub-periosteal drainage group (closed group). The surgical efficacy and complications of the two groups were statistically analyzed.

Results

There was no statistically significant difference in surgical efficacy between the two groups (Z=0.262, P>0.05) . The intracranial pneumatocele in closed group was significantly less than that in conventional group (Z=3.963, P<0.05). There was no significant difference in the incidence of postoperative symptomatic pneumocephalus, brain injury, cerebrospinal fluid leakage, epilepsy and hematoma recurrence between the two groups (P>0.05).

Conclusion

The treatment of CSDH by single burr-hole irrigation and continuous closed sub-periosteal drainage can significantly reduce the intracranial pneumatocele after operation, which is a simple, effective and safe treatment method.

Key words: Chronic subdural hematoma, Closed burr hole drainage, Subperiosteal drainage, Intracranial pneumatosis
表1 2组患者整体治疗效果比较[例(%)]
组别 例数 治愈 好转 未愈
常规组 82 70（85.3） 8（9.8） 4（4.9）
封闭组 24 21（87.5） 2（8.3） 1（4.2）
Z值 ? ? 0.262 ?
P值 ? ? 0.793 ?
表2 2组患者的并发症情况比较[例（%）]
组别 例数 症状性气颅 脑损伤 脑脊液漏 癫痫 复发 并发症总计
常规组 82 4（4.88） 1（1.22） 2（2.44） 6（7.32） 8（9.76） 21（25.61）
封闭组 24 0 0 0 1（4.17） 1（4.17） 2（8.33）
χ2值 ? 1.217 0.295 0.597 0.299 0.747 3.262
P值 ? 0.270 0.587 0.440 0.585 0.388 0.071
表3 2组患者的术后颅内积气量比较[例（%）]
组别 例数 <5 mL 5~14 mL 15~29 mL ≥30 mL
常规组 95 18（18.9） 40（42.1） 32（33.7） 5（5.3）
封闭组 28 12（42.9） 16（57.1） 0 0
Z值 ? ? 3.963 ?
P值 ? ? 0.000 ?
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