摘要
目的探讨青年(14~44岁)慢性硬膜下血肿(CSDH)的临床特点、治疗方法及疗效。方法回顾性分析2011年1月至2022年12月收治的38例青年CSDH的临床资料。结果38例中,男32例,女6例;合并蛛网膜囊肿15例、凝血因子Ⅷ活性下降1例、Ⅺ因子活性下降1例;因脑积水行脑室-腹腔分流术2例;长期高血压病史2例;急性硬膜下血肿转化成CSDH有2例;15例无其它疾病。1例合并凝血因子Ⅷ活性下降,未行手术治疗且自动出院后失访;其余37例行钻孔引流术治疗,其中28例一次手术即治愈,9例首次术后复发(再次手术4例,保守治疗5例);1例术中即见脑组织完全回复,4例术后3 d内脑组织完全回复,17例术后7 d~1个月内脑组织完全回复,5例术后1个月后脑组织完全回复;术后随访1~12年,未再复发,正常生活。结论青年CSDH以男性多见,常合并有其它疾病(蛛网膜囊肿、凝血功能障碍等);治疗首选钻孔引流术,预后良好,但需重视合并疾病的治疗;合并有蛛网膜囊肿者,术后再出血率高,如无颅内压增高,可采用随访观察。
Objective To investigate the clinical characteristics,and treatment and its curative effectiveness of chronic subdural hematoma(CSDH)in patients aged 14 to 44 years.Methods The clinical data of 38 patients(age,14~44 years)with CSDH who were admitted to our hospital from January 2011 to December 2022 were retrospectively analyzed.Results Of these 38 patients,32 were male and 6 female.Fifteen patients had arachnoid cyst,1 had decreased activity of coagulation factorⅧ,and 1 had decreased activity of factorⅪ.Two patients underwent ventriculoperitoneal shunt due to hydrocephalus.Two patients had hypertension.Acute subdural hematoma converted to CSDH in 2 patients.Fifteen patients had no comorbidities.One patient with decreased activity of coagulation factorⅧreceived conservetive treatment and was automaticly discharged to lost follow-up.Burr hole drainage(BHD)was performed in the other 37 patients,of whom 28 patients were cured after one operation,and 9 recurred after the first operation(4 received BHD again,5 conservative treatment).Complete brain tissue recovery was observed in 1 patient during the operation,in 4 patients within 3 days after the operation,in 17 patients within 7 d~1 month after the operation,and in 5 patients within 1 month after the operation.Postoperative follow-up(range,1~12 years)showed no recurrence in the 37 patients with normal life.Conclusions CSDH is more common in young men,and is often complicated with other diseases(arachnoid cyst,coagulation dysfunction,etc.).The first choice of treatment is the BHD,which can achieve a good prognosis,but attention should be paid to the treatment of the comorbidities.Patients with arachnoid cysts have a high rate of rebleeding after BHD.If patients have no intracranial hypertension,follow-up observation can be used.
作者
左大辉
蒋太鹏
何嘉滨
林恒州
王建中
ZUO Da-hui;JIANG Tai-peng;HE Jia-bin;LIN Heng-zhou;WANG Jian-zhong(Department of Neurosurgery,The Second Shenzhen People's Hospital/The First Affiliated Hospital of Shenzhen University,Shenzhen 518035,China)
出处
《中国临床神经外科杂志》
2023年第9期559-562,共4页
Chinese Journal of Clinical Neurosurgery
关键词
慢性硬膜下血肿
青年人
临床特征
蛛网膜囊肿
Chronic subdural hematoma
Clinical characteristics
Young people
Arachnoid cyst
