微孔导管浣洗术治疗慢性硬膜下血肿

发布时间：2018-04-06 22:17

本文选题：慢性硬膜下血肿　切入点：微孔导管浣洗术　出处：《河北医科大学》2015年硕士论文

【摘要】：目的:慢性硬膜下血肿是神经外科常见病,治疗以外科手术为主,现在外科手术越来越微创化、精细化。现在介绍一种新的慢性硬膜下血肿治疗方法-微孔导管浣洗术,并讨论其特点及疗效。方法:回顾性分析我院自2009年2月至2014年12月间128例慢性硬膜下血肿行穿刺手术患者。将128例患者分成两组,实验组和对照组,其中实验组86例患者行微孔导管浣洗术,对照组42例患者行YL-1硬通道穿刺引流术。两组在年龄、性别、有无基础病及血肿大小等方面无统计学差异。实验组男性76例,女性10例;年龄35~90岁,平均71.7岁,单侧血肿73例,双侧血肿13例,共计99侧血肿,有明确头外伤史69例。86例全部行微孔导管浣洗术。术后保留引流管,间断抽吸浣洗血肿,复查头颅CT,据CT结果适时拔管。一般引流管留置2~3天,冲洗2~3次。术后据改良Markwalder的CSDH评分评估治疗效果。对照组男性36例,女性6例;年龄36~88岁,平均70.6岁,单侧血肿35例,双侧血肿7例,共计49侧血肿,有明确头外伤史28例。42例全部行YL-1硬通道穿刺引流术。术后接引流袋持续头低位引流,可间断冲洗,复查头颅CT,据CT结果适时拔管。一般引流管留置3~4天,冲洗2~3次。术后据改良Markwalder的CSDH评分评估治疗效果。结果:实验组术后一次性治愈78例(90.7%),好转8例(9.3%),总有效率100%,其中血肿复发4例(4.6%),颅内感染0例,术后发生硬膜外血肿1例(1.1%),张力性气颅0例。对照组术后一次性治愈28例(66.7%),好转9例(21.4%),总有效率88%,其中血肿复发8例(19%),颅内感染2例(4.7%),术后发生硬膜外血肿3例(7.1%),颅内血肿2例(4.7%),张力性气颅17例(40.4%)。结论:慢性硬膜下血肿微创手术治疗与传统微创方式相比微孔导管浣洗术具有创伤小,操作简单,易推广,且病死率低,并发症少,恢复快的优点,对慢性硬膜下血肿病人是一种较理想的微创手术方式。
[Abstract]:Objective: chronic subdural hematoma is a common neurosurgical disease.This paper introduces a new treatment method of chronic subdural hematoma, micropore catheter washing, and discusses its characteristics and curative effect.There was no significant difference in age, sex, basic disease and hematoma size between the two groups.There were 76 males and 10 females in the experimental group, age 3590 years (mean 71.7 years), unilateral hematoma 73 cases, bilateral hematoma 13 cases, a total of 99 side hematoma. 69 cases (86 cases) with definite history of head trauma were washed by microcatheter.After operation, the drainage tube was retained, the hematoma was washed by intermittent aspiration, and CTT was rechecked. The catheter was removed timely according to the CT results.General drainage tube indwelling for 2 days, flushing 2 times 3 times.The therapeutic effect was evaluated by modified Markwalder CSDH score after operation.The control group consisted of 36 males and 6 females, aged 36 88 years (mean 70.6 years), 35 unilateral hematoma and 7 bilateral hematoma, with a total of 49 hematomas. 28 cases with definite history of head trauma were treated with YL-1 hard channel puncture drainage.Continuous head-low drainage with drainage bag after operation, intermittent washing, reexamination of head CTs, timely extubation according to CT results.General drainage tube indwelling for 3 days, flushing 2 times 3 times.The therapeutic effect was evaluated by modified Markwalder CSDH score after operation.Results: in the experimental group, 78 cases were cured at one time, 9. 3 were improved in 8 cases, the total effective rate was 100, including 4 cases of hematoma recurrence, 4 cases of intracranial infection, 1 case of epidural hematoma and 1 case of tension pneumocranium.Conclusion: compared with the traditional minimally invasive treatment of chronic subdural hematoma, microcatheter washing has the advantages of less trauma, simple operation, easy popularization, low mortality, less complications and quick recovery.It is an ideal minimally invasive operation for patients with chronic subdural hematoma.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.15

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