摘要
目的:探讨机化型慢性硬膜下血肿(OCSDH)临床上行不同手术治疗方案与患者预后的关系,并评估其治疗效果、影响因素及机制。方法:收集整理2011年11月至2013年11月期间4例OCSDH患者的临床病例资料,采用回顾性分析方法,按手术方式分为2组,其中一组为钻孔引流术后再采用开颅机化血肿清除术,另一组直接采用大骨瓣开颅血肿清除术。组内比较患者术前与术后神志、GCS评分、体格检查、影像学表现等,组间比较术后GOS评分变化等,最后分析2种手术方式及术中机化血肿皮层侧包膜是否剥除与疾病预后的相关性。结果:术中切除皮层侧机化血肿包膜的2例患者术后预后不佳,1例死亡,1例出现双眼向上凝视和运动性失语;术中未切除包膜的2例患者预后可,术后神经功能改善。结论:对于OCSDH,我们建议采用直接开颅机化血肿清除术,且予以保留皮层侧机化包膜,利于患者术后病情的改善。
Objective： To explore the relationship between different surgical regimens and the prognosis of patients with organized chronic subdural hematoma （OCSDH）, and to evaluate contributing factors influencing surgical outcome. Methods： Clinical data of patients with OCSDH in the First Affiliated Hospital of Wenzhou Medical University from April 2011 to November 2013 were collected retrospectively. A total of 4 patients with OCSDH were identified and divided into 2 groups according to the two different operation methods, burr-hole drainage followed by craniotomy for hematoma removal, or direct-craniotomy for hematoma removal. Com- parison between the two groups in terms of their preoperative and postoperative consciousness, GCS, physical examination, imaging, and the different surgical methods were compared. The relevance of membranectomy of OCSDH envelope firmly attached to the cerebral cortex, to prognosis of disease was also analyzed. Results： Pa- tients who underwent membranectomy of OCSDH envelope had poor prognosis after surgery, one death and the other showed upward gaze and motor aphasia; the group with no resection of the envelope during surgery had better prognosis and neurological function. Conclusion： For OCSDH with envelope attached to cerebral cortex, we recommend the use of craniotomy for hematoma removal, without membranectomy of OCSDH envelope firmly attached to the cerebral cortex, since that results in to the better prognosis.
出处
《温州医科大学学报》
CAS
2017年第12期906-909,913,共5页
Journal of Wenzhou Medical University
关键词
机化型慢性硬膜下血肿
手术治疗
预后
organized chronic subdural hematoma
surgical therapy
prognosis
