两种硬膜下引流方式治疗慢性硬膜下血肿的疗效分析Clinical analysis of two subdural drainage methods in the treatment of chronic subdural hematomas
刘海巍;陶胜忠;
摘要(Abstract):
目的比较颅骨钻孔T管引流术和常规硬膜下引流术治疗慢性硬膜下血肿(CSDH)的临床治疗效果,为临床手术方式的选择提供参考。方法回顾性分析2011-12-2018-12驻马店市第一人民医院神经外科收治的108例CSDH患者的临床资料,按引流方法分为T管引流组和常规硬膜下引流组,并对相关变量进行统计学分析。结果 2组手术时间、住院时间、术后3个月Markwalder神经功能分级方面无显著性差异(P>0.05)。T管引流组术后并发症发生率和血肿复发率均低于常规硬膜下引流组(P<0.05)。结论两种手术方法均取得了较好的治疗效果,但T管引流术总体术后并发症发生率和血肿复发率均低于常规硬膜下引术,表明颅骨钻孔T管引流术可能是治疗CSDH更好的手术选择。
关键词(KeyWords): 慢性硬膜下血肿;颅骨钻孔;T管引流术;常规硬膜下引流术;术后并发症;血肿复发
基金项目(Foundation): 2018年河南省科技厅科技攻关资助项目(编号:182102310711)
作者(Authors): 刘海巍;陶胜忠;
参考文献(References):
- [1] ASGHAR M,ADHIYAMAN V,GREENWAY M W,et al.Chronic subdural haematoma in the elderly:A North Wales experience[J].J R Soc Med,2002,95(6):290-292.
- [2] KUDO H,KUWAMURA K,IZAWA I,et al.Chronic subdural hematoma in elderly people:Present status on Awaji Island and epidemiological prospect[J].Neurol Med Chir (Tokyo),1992,32(4):207-209.
- [3] IORIO-MORIN C,BLANCHARD J,RICHER M,et al.Tranexamic acid in chronic subdural hematomas (TRACS):study protocol for a randomized controlled trial[J].Trials,2016,17(1):1-11.
- [4] JIANG R,WANG D,SANG POON W,et al.Effect of ATorvastatin On Chronic subdural Hematoma (ATOCH):a study protocol for a randomized controlled trial[J].Trials,2015,16:528.
- [5] MORJARIA P,MURALI K,EVANS J,et al.Spectacle wearing in children randomised to ready-made or custom spectacles,and potential cost savings to programmes:study protocol for a randomised controlled trial.[J].Trials,Trials.2016,17:36.
- [6] EDLMANN E,GIORGI-COLL S,WHITFIELD P C,et al.Pathophysiology of chronic subdural haematoma:inflammation,angiogenesis and implications for pharmacotherapy[J].J Neuroin-flamm.2017,14(1):1-13.
- [7] SINDOU M,IBRAHIM I,MAARRAWI J.Chronic subdural hematomas:twist drill craniostomy with a closed system of drainage,for 48 hours only,is a valuable surgical treatment[J].Acta Neurochir (Wien),2010,152(3):545-556.
- [8] ISHIBASHI A,YOKOKURA Y,ADACHI H.A comparative study of treatments for chronic subdural hematoma:burr hole drainage versus burr hole drainage with irrigation[J].Kurume Med J,2011,58(1):35-39.
- [9] TAKAHASHI S,YAZAKI T,NITORI N,et al.Neuroendoscope-assisted removal of an organized chronic subdural hematoma in a patient on bevacizumab therapy:case report[J].Neurol Med Chir,2011,51(7):515-518.
- [10] LEGA B C,DANISH S F,MALHOTRA N R,et al.Choosing the best operation for chronic subdural hematoma:a decision analysis[J].J Neurosurg,2010,113(9):615-621.
- [11] MINO M,NISHIMURA S,HORI E,et al.Efficacy of middle meningeal artery embolization in the treatment of refractory chronic subdural hematoma[J].Surg Neurol Int,2010,1:78.
- [12] MANDAI S,SAKURAI M,MATSUMOTO Y.Middle meningeal artery embolization for refractory chronic subdural hematoma.Case report[J].J Neurosurg,2000,93(4):686-688.
- [13] TAKAHASHI K,MURAOKA K,SUGIURA T,et al.Middle meningeal artery embolization for refractory chronic subdural hematoma:3 case reports[J].No Shinkei Geka,2002,30(5):535-539.
- [14] 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.
- [15] SAMBASIVAN M.An overview of chronic subdural hematoma:experience with 2300 cases[J].Surg Neurol,1997,47:418-422.
- [16] MONDORF Y,ABU-OWAIMER M,GAAB MR,et al.Chronic subdural hematoma craniotomy versus burr hole trepanation[J].Br J Neurosurg,2009,23:612-616.
- [17] REGAN J M,WORLEY E,SHELBURNE C,et al.Burr hole washout versus craniotomy for chronic subdural hematoma:patient outcome and cost analysis[J].PLoS One,2015,10:e0115085.
- [18] LU W,WANG H,WU T,et al.Burr-Hole Craniostomy with T-Tube Drainage as Surgical Treatment for Chronic Subdural Hematoma[J].World Neurosurg.2018,115:e756-e760.
- [19] MARKWALDER T M,STEINSIEPE K F,ROHNER M,et al.The course of chronic subdural hematomas after burr-hole craniostomy and closed-system drainage[J].J Neurosurg 1981,5:390-396.
- [20] ABOUZARI M,RASHIDI A,REZAII J,et al.The role of postoperative patient posture inthe recurrence of traumatic chronic subdural hematoma after burr-hole surgery[J].Neurosurgery,2007,61(4):794-797.
- [21] MARKWALDER T M.Chronic subdural hematomas:A review[J].J Neurosurg,1981,54(5):637-645.
- [22] TAKIZAWA K,SORIMACHI T,HONDA Y,et al.Chronic subdural hematomas associated with arachnoid cysts:Significance in young patients with chronic subdural hematomas[J].Neurol Med Chir (Tokyo),2015,55(9):727-734.
- [23] BRENNAN P M,KOLIAS A G,JOANNIDES A J,et al.The management and outcome for patients with chronic subdural hematoma:Aprospective,multicent-er,observational cohort study in the United Kingdom[J].J Neurosurg,2017,127(4):732-739.
- [24] WU X,LI G,ZHAO J,et al.Arachnoid cyst-associated chronic subdural hematoma:Report of 14 cases and a systematic literature review[J].World Neurosurg,2018,109:e118-e130.
- [25] SANTARIUS T,KIRKPATRICK P J,KOLIAS A G,et al.Working toward rational and evidence-based treatment of chronic subdural hematoma[J].Clin Neurosurg,2010,57:112-122.
- [26] BELKHAIR S,PICKETT G.One versus double burr holes for treating chronic subdural hematoma meta-analysis[J].Can J Neurol Sci,2013,40(1):56-60.
- [27] SANTARIUS T,KIRKPATRICK P J,KOLIAS A G,et al.The management and outcome for patients with chronic subdural hematoma:a prospective,multicenter,observational cohort study in the United Kingdom[J].J Neurosurg.2017,17:1-8.
- [28] MEAGHERR J.Subduralhematoma[J].Medscape.2017.https://emedicine.Medscape.com/article/1137207-overview.
- [29] ILIESCUI A.Current diagnosis and treatment of chronic subdural haematomas[J].J Med Life,2015,8(3):278-284.
- [30] YADAV Y R,PARIHAR V,NAMDEV H,et al.Chronic subdural hematoma[J].Asian J Neurosurg,2016,11(4):330-342.
- [31] ORAL S,BORKLU R E,KUCUK A,et al.Comparison of subgaleal and subdural closed drainage system in the surgical treatment of chronic subdural hematoma[J].North Clin Istanbul.2015,2(2):115-121.
- [32] ENGLEHARD H H III.Subdural hematoma surgery[J].Medscape.2015.https://eme dici-ne.medscape.com/article/247472-overview.
- [33] CHIH A N,HIENG A W,RAHMAN N A,et al.Subperiosteal drainage versus subdural drainage in the management of chronic subdural hematoma (a comparative study)[J].Malays J Med Sci,2017,24(1):21-30.
- [34] OKADA Y,AKAI T,OKAMOTO K,et al.A comparative study of the treatment of chronic subdural hematoma-burr hole drainage versus burr hole irrigation[J].Surg Neurol,2002,57(6):405-409.
- [35] WEIGEL R,SCHMIEDEK P,KRAUSS JK.Outcome of contemporary surgery for chronic subdural haematoma:evidence based review[J].J Neurol Neurosurg Psychiatry,2003,74(7):937-943.
- [36] LEE J Y,EBEL H,ERNESTUS R I,et al.Various surgical treatments of chronic subdural hematoma and outcome in 172 patients:is membranectomy necessary?[J].Surg Neurol,2004,61(6):523-527.
- [37] LIU W,BAKKER N A,GROEN R J.Chronic subdural hematoma:a systematic review and meta-analysis of surgical procedures[J].J Neurosurg,2014,121(3):665-673.
- [38] SCHIRMER C M,HEILMAN C B,BHARDWAJ A.Pneumocephalus:case illustrations and review[J].Neurocrit Care,2010,13(1):152-158.
- [39] ZAKARAIA A M,ADNAN J S,HASPANI M S,et al.Outcome of 2 different types of operative techniques practiced for chronic subdural hematoma in Malaysia:an analysis[J].Surg Neurol,2008,69(6):608-616.
- [40] IHAB Z.Pneumocephalus after surgical evacuation of chronic subdural hematoma:is it a serious complication?[J].Asian J Neurosurg,2012,7(2):66-74.
- [41] REASONER D K,TODD M M,SCAMMAN F L,et al.The incidence of pneumocephalus after supratentorial craniotomy:observations on the disappearance of intracranial air[J].Anesthesiology,1994,80(5):1 008-1 012.
- [42] RYCHLICKI F,RECCHIONI M A,BURCHIANTI M,et al.Percutaneous twist drill craniostomy for treatment of chronic subdural haematoma[J].Acta Neurochir.1991,113(1/2):38-41.
- [43] LEUNG G K,FAN J K,TAM M C,et al.Surgical complications of chronic subdural haematoma:a 5-year audit[J].Ann Coll Surg HK,2001,80(5):99-103.
- [44] DUCRUET A F,GROBELNY B T,ZACHARIA B E,et al.The surgical management of chronic subdural hematoma[J].Neurosurg Rev,2012,35(2):155-169.