<trans-title xml:lang="en"/>_West China Medical Journal

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^1，2 , ² , ² ,  ¹

1. ;
2. ;

Corresponding author：

, Email: 187317846@qq.com

Keywords：

慢性硬膜下血肿; 钻孔引流; 冲洗; 3D-Slicer

DOI：

10.7507/1002-0179.201506056

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目的对比分析慢性硬膜下血肿钻孔引流术中冲洗与不冲洗不同手术操作方法对患者术后疗效及并发症的影响。方法回顾性收集 2013 年 1 月—2014 年 12 月在四川大学华西医院神经外科就诊的 81 例单侧慢性硬膜下血肿患者临床及影像学资料，患者分别采用钻孔引流+术中生理盐水彻底冲洗+术后引流治疗（冲洗组 46 例）及钻孔置管引流不行冲洗治疗（引流组 35 例），应用 3D-Slicer 软件精确测量术后 1 d 颅内积气量及出院残余血肿量，对测量数据及并发症发生情况进行对比分析，并利用术后门诊随访及电话随访资料对比分析血肿复发情况。结果术后第 2 天冲洗组与引流组患者颅内积气量分别为（9.98±4.73）、（3.78±1.80）mL，差异有统计学意义（P<0.05）；冲洗组与引流组术后发生新鲜出血概率分别为 6.5%、2.9%，出院前残余血肿量分别为（9.82±3.20）、（10.94±4.34）mL，血肿复发率分别为 6.5%、8.6%，差异均无统计学意义（P>0.05）。结论钻孔引流术中冲洗能快速引流出硬膜下血肿，但明显增加术后颅内积气，并可能增加出血风险，且远期疗效与不冲洗组相比无明显差异，故钻孔引流无需术中冲洗。由于样本量及设计学缺陷，尚需大规模随机对照试验作进一步验证。

Citation： 易勇, 王强平, 周章明, 关俊文. . West China Medical Journal, 2017, 32(2): 213-216. doi: 10.7507/1002-0179.201506056 Copy

1.	Miranda LB, Braxton E, Hobbs J, et al. Chronic subdural hematoma in the elderly: not a benign disease. J Neurosurg, 2011, 114(1): 72-76.
2.	Santarius T, Kirkpatrick PJ, Kolias AG, et al. Working toward rational and evidence-based treatment of chronic subdural hematoma. Clin Neurosurg, 2010, 57: 112-122.
3.	Belkhair S, Pickett G. One versus double burr holes for treating chronic subdural hematoma Meta-analysis. Can J Neurol Sci, 2013, 40(1): 56-60.
4.	De BP, Trevisi G, De WC, et al. Antiplatelet/anticoagulant agents and chronic subdural hematoma in the elderly. PLoS One, 2013, 8(7): e68732.
5.	Tahsim OY, Beseoglu K, Haenggi DA, et al. Factors predicting recurrence of chronic subdural haematoma: the influence of intraoperative irrigation and low-molecular-weight heparin thromboprophylaxis. Acta Neurochir, 2012, 154(6): 1063-1068.
6.	田昵军, 姜武. 微创锥孔引流与常规钻孔引流治疗慢性硬膜下血肿的临床疗效对照分析. 河北医学, 2014, 20(11): 1822-1824.
7.	Saadoun S, Papadopoulos MC. Aquaporin-4 in brain and spinal cord oedema. Neuroscience, 2010, 168(4): 1036-1046.
8.	Kuroki, T, Katsume M, Harada N, et al. Strict closed-system drainage for treating chronic subdural haematoma. Acta Neurochirurgica, 2001. 143(10): 1041-1044.
9.	何东升, 赵强, 王德全, 等. 外伤性硬膜下积液演变成慢性硬膜下血肿的临床分析. 华西医学, 2005, 20(1): 96-96.
10.	谢轩贵, 游潮, 蔡博文. 33 例老年双侧慢性硬膜下血肿的诊断与治疗. 华西医学, 2005, 20(2): 317-318.
11.	Iftikhar M, Siddiqui UT, Rauf MY, et al. Comparison of irrigation versus no irrigation during burr hole evacuation of chronic subdural hematoma. J Neurol Surg A Cent Eur Neurosurg, 2016, 77(5): 416-421.
12.	Berghauser Pont LM, Dippel DW, Verweij BH, et al. Ambivalence among neurologists and neurosurgeons on the treatment of chronic subdural hematoma: a national survey. Acta Neurol Belg, 2013, 113(1): 55-59.
13.	Tempaku A, Yamauchi S, Ikeda H, et al. Usefulness of interventional embolization of the middle meningeal artery for recurrent chronic subdural hematoma: five cases and a review of the literature. Interv Neuroradiol, 2015, 21(3): 366-371.
14.	Weigel R, Schmiedek P, Krauss JK. Outcome of contemporary surgery for chronic subdural haematoma:evidence based review. J Neurol Neurosurg Psychiatry, 2003, 74(7): 937-943.
15.	Ishibashi A, Yokokura Y, Adachi H. A comparative study of treatments for chronic subdural hematoma: burr hole drainage versus burr hole drainage with irrigation. Kurume Med J, 2011, 58(1): 35-39.

1. Miranda LB, Braxton E, Hobbs J, et al. Chronic subdural hematoma in the elderly: not a benign disease. J Neurosurg, 2011, 114(1): 72-76.
2. Santarius T, Kirkpatrick PJ, Kolias AG, et al. Working toward rational and evidence-based treatment of chronic subdural hematoma. Clin Neurosurg, 2010, 57: 112-122.
3. Belkhair S, Pickett G. One versus double burr holes for treating chronic subdural hematoma Meta-analysis. Can J Neurol Sci, 2013, 40(1): 56-60.
4. De BP, Trevisi G, De WC, et al. Antiplatelet/anticoagulant agents and chronic subdural hematoma in the elderly. PLoS One, 2013, 8(7): e68732.
5. Tahsim OY, Beseoglu K, Haenggi DA, et al. Factors predicting recurrence of chronic subdural haematoma: the influence of intraoperative irrigation and low-molecular-weight heparin thromboprophylaxis. Acta Neurochir, 2012, 154(6): 1063-1068.
6. 田昵军, 姜武. 微创锥孔引流与常规钻孔引流治疗慢性硬膜下血肿的临床疗效对照分析. 河北医学, 2014, 20(11): 1822-1824.
7. Saadoun S, Papadopoulos MC. Aquaporin-4 in brain and spinal cord oedema. Neuroscience, 2010, 168(4): 1036-1046.
8. Kuroki, T, Katsume M, Harada N, et al. Strict closed-system drainage for treating chronic subdural haematoma. Acta Neurochirurgica, 2001. 143(10): 1041-1044.
9. 何东升, 赵强, 王德全, 等. 外伤性硬膜下积液演变成慢性硬膜下血肿的临床分析. 华西医学, 2005, 20(1): 96-96.
10. 谢轩贵, 游潮, 蔡博文. 33 例老年双侧慢性硬膜下血肿的诊断与治疗. 华西医学, 2005, 20(2): 317-318.
11. Iftikhar M, Siddiqui UT, Rauf MY, et al. Comparison of irrigation versus no irrigation during burr hole evacuation of chronic subdural hematoma. J Neurol Surg A Cent Eur Neurosurg, 2016, 77(5): 416-421.
12. Berghauser Pont LM, Dippel DW, Verweij BH, et al. Ambivalence among neurologists and neurosurgeons on the treatment of chronic subdural hematoma: a national survey. Acta Neurol Belg, 2013, 113(1): 55-59.
13. Tempaku A, Yamauchi S, Ikeda H, et al. Usefulness of interventional embolization of the middle meningeal artery for recurrent chronic subdural hematoma: five cases and a review of the literature. Interv Neuroradiol, 2015, 21(3): 366-371.
14. Weigel R, Schmiedek P, Krauss JK. Outcome of contemporary surgery for chronic subdural haematoma:evidence based review. J Neurol Neurosurg Psychiatry, 2003, 74(7): 937-943.
15. Ishibashi A, Yokokura Y, Adachi H. A comparative study of treatments for chronic subdural hematoma: burr hole drainage versus burr hole drainage with irrigation. Kurume Med J, 2011, 58(1): 35-39.

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