总结不同类型硬膜下积液治疗经验。

对解放军总医院第六医学中心神经外科自2009年1月至2014年10月手术治疗并完整随访的27例硬膜下积液患者进行回顾性分析。根据术前影像学特征鉴别积液是否为血性，将患者分为血性硬膜下积液患者（9例）和非血性硬膜下积液患者（18例）。根据积液是否为血性选择个性化治疗方案，观察其疗法。

9例血性硬膜下积液患者接受钻孔外引流手术，8例积液消退，另外1例无效，之后接受硬膜下腹腔分流后治愈。非血性硬膜下积液患者中14例接受硬膜下腹腔分流，12例有效，2例术后出现脑积水，经脑室-腹腔分流术治愈；2例术前合并脑积水接受脑室-腹腔分流术，均有效；另外2例最初接受积液外引流，无效，之后行硬膜下腹腔分流后积液消退。

对于硬膜下积液患者，术前需仔细评估积液是否为血性，是否合并脑积水。血性积液采取钻孔外引流，非血性积液采取硬膜下腹腔分流，合并脑积水的积液采取脑室-腹腔分流手术方式，给予个体化治疗，可获得满意疗效。

To summarize the treatment experience of different kinds of subdural effusion.

Twenty-seven patients with subdural effusion who underwent surgery and were followed up completely from January 2009 to October 2014 in Neurosurgery Department of the Sixth Medical Center of PLA General Hospital were retrospectively analyzed. According to the preoperative imaging features, the patients were divided into bloody subdural effusion (9 patients) and non bloody subdural effusion (18 patients). According to whether the effusion is bloody or not, the individualized treatment plan was selected and observed.

Nine patients with bloody subdural effusion underwent extradrilling drainage, 8 patients of effusion subsided, and 1 patient was invalid. After that, the patients were cured by subaracheal abdominal shunt. 14 patients with non bloody subdural effusion received subdural abdominal shunt, 12 patients were effective, and 2 patients had hydrocephalus after operation, which were cured by ventriculoperitoneal shunt; 2 patients with hydrocephalus were treated by ventriculoperitoneal shunt, all of which were effective; the other 2 patients received initial drainage of effusion, which was ineffective, and then the effusion disappeared after subdural abdominal shunt.

For patients with subdural effusion, it is necessary to carefully evaluate whether the effusion is bloody and whether it is complicated with hydrocephalus. The patients with hemorrhagic effusion were treated with extra drilling drainage, non bloody effusion with subdural intraperitoneal shunt, and those with hydrocephalus were treated by ventriculoperitoneal shunt operation. Satisfactory results could be obtained by individualized treatment.