CAJ | 학술논문

目的探讨快速细孔钻颅置管引流术治疗慢性硬脑膜下血肿(CSDH)的疗效,为CSDH的治疗提供临床经验.方法回顾自1970年应用自主研发的快速细孔钻颅置管引流术治疗510例CSDH患者的临床资料,结合1例CSDH死亡患者尸体解剖资料进行相关讨论.全部病例经脑血管造影、颅脑CT或MRI确诊,血肿引流量60 ～ 340 ml,多为80 ～ 120 ml.快速细孔钻颅一般选择顶结节处或在血肿最厚部位为钻颅点,根据头皮及颅骨厚度确定钻头前段长度,穿刺成功后置管持续低位引流3～5d.手术应注意精确限制钻头前段长度、选择血肿最厚处穿刺、术后及时复查颅脑CT.结果全部病例采用快速细孔钻颅置管引流手术,手术时间单侧3 ～5 min左右,双侧6-8 min.引流时间2～8d,多数病例引流3～5d.治愈433例(84.9％),好转75例(14.9％),死亡2例(0.4％).手术穿刺致硬膜外血肿2例,引流管误插入脑室质内形成少量血肿1例.结论快速细孔钻颅置管引流术是治疗CSDH安全、有效、简易、快捷的微创手术方式.
목적 탐토쾌속세공찬로치관인류술치료만성경뇌막하혈종(CSDH)적료효,위CSDH적치료제공림상경험.방법 회고자1970년응용자주연발적쾌속세공찬로치관인류술치료510례CSDH환자적림상자료,결합1례CSDH사망환자시체해부자료진행상관토론.전부병례경뇌혈관조영、로뇌CT혹MRI학진,혈종인류량60 ～ 340 ml,다위80 ～ 120 ml.쾌속세공찬로일반선택정결절처혹재혈종최후부위위찬로점,근거두피급로골후도학정찬두전단장도,천자성공후치관지속저위인류3～5d.수술응주의정학한제찬두전단장도、선택혈종최후처천자、술후급시복사로뇌CT.결과 전부병례채용쾌속세공찬로치관인류수술,수술시간단측3 ～5 min좌우,쌍측6-8 min.인류시간2～8d,다수병례인류3～5d.치유433례(84.9％),호전75례(14.9％),사망2례(0.4％).수술천자치경막외혈종2례,인류관오삽입뇌실질내형성소량혈종1례.결론 쾌속세공찬로치관인류술시치료CSDH안전、유효、간역、쾌첩적미창수술방식.
Objective To explore the treatment effect of rapid small hole cranio-puncture apparatus for the chronic subdural hematoma (CSDH) drainage,and povide clinical experiences of CSDH treatment.Methods The clinical data of 510 patients of CSDH treated by rapid small hole cranio-puncture apparatus of self-development and autopsy data of one patient died of CSDH were retrospectively studied.All the cases were diagnosed with cerebral angiography,CT or MRI.The parietal tuber or the thickest site of hematoma was usually used as the puncture point,and the length of drill's forepart was designed by the thickness of scalp and skulls.Continuous low position catheter drainage was adopted for 3 to 5 days after surgery.Accurate length restriction of the drill's forepart,puncturing the thickest site of hematoma,and timely cerebral CT examination should be noticed.Results In all patients treated of rapid small hole cranio-puncture,the operating time was only 3 to 5 minutes with unilateral puncture,while bilateral puntcure needed 6 to 8 minutes.The hemorrhage drainage volume was among 60 to 340 ml,mostly 80 to 120 ml,and the drainage duration was among 2 to 8 days,mostly 3 to 5 days.433 patients (84.9％) patients were cured,75 patients got improvement (14.9％),and 2 patient (0.4％) died.The complications included epidural hematoma (2 cases,0.4％) and little intracerebral hematoma induced by the drainage tube inserted into the brain parenchyma incautiously (1 case,0.2％).Conclusions Drainage of CSDH via rapid small hole cranio-puncture apparatus was effective,safe,simple and fast.