CAJ | 학술논문

目的：探讨慢性硬膜下血肿钻孔引流术后再出血的原因及治疗原则。方法回顾性分析2011年7月～2013年6月收治的80例慢性硬膜下血肿钻孔引流术治疗患者的临床资料，其中4例患者出现包膜内出血形成血肿，患者均手术治疗并对血肿外包膜做病理检查。结果3例手术治疗后痊愈，1例因术后并发症死亡。包膜病理检查示，大量新生毛细血管扩张充血，有炎性细胞、胶原纤维和纤维细胞等，包膜内的毛细血管壁不完整。结论慢性硬膜下血肿外膜新生血管结构异常是慢性硬膜下血肿术后包膜内出血的原因之一，包膜内出血一经确诊应首选手术治疗。
목적：탐토만성경막하혈종찬공인류술후재출혈적원인급치료원칙。방법회고성분석2011년7월～2013년6월수치적80례만성경막하혈종찬공인류술치료환자적림상자료，기중4례환자출현포막내출혈형성혈종，환자균수술치료병대혈종외포막주병리검사。결과3례수술치료후전유，1례인술후병발증사망。포막병리검사시，대량신생모세혈관확장충혈，유염성세포、효원섬유화섬유세포등，포막내적모세혈관벽불완정。결론만성경막하혈종외막신생혈관결구이상시만성경막하혈종술후포막내출혈적원인지일，포막내출혈일경학진응수선수술치료。
Objective To explore mechanism and management of intracapsular bleeding after burr hole subdural drainage for chronic subdural hematoma ( CSDH) .Method The clinical data of 80 patients with CSDH treated with burr hole subdural drainage from July , 2011 to June,2013,were analyzed retrospectively .4 cases were treated with craniotomy because of hematoma in capsule after burr hole subdural drainage , light microscopy was used to observe the ultrastructure of the outer membrane of them .Results 3 patients were cured after craniotomy ,1 died because of complication .Light microscopy showed dilated and congested marcocapillaries with a wide vascular lumen in the outer membrane of the hematoma capsule , including inflammatory cells , collagenous fiber , fibrocyte and so on , endothelial cell in the marcocapillaries was discontinous or partically dissolved .Conclusions Variation of structure of these fragile new vessels may play an important role in bleeding of capsule after burr hole subdural drainage in treatment of CSDH.Craniotomy should be the first line treatment .