【摘要】 目的 探讨慢性硬膜下血肿(CSDH)的发病机制、临床特点和治疗方法。方法 回顾性分析20年间前后两个阶段诊治的慢性硬脑膜下血肿316例，并从临床特点、影像学资料、预后、并发症以及两种手术疗效进行比较。结果 87.3%的患者恢复良好，10.7%无改变或加重，病死率为1.9% 。细孔钻孔+密闭式硬通道引流与颅骨钻孔+软管引流相比，术后并发症减少，再手术率低。结论 细孔钻孔+密闭式硬通道引流手术，操作简单，用时短，安全有效，适合各年龄组，值得推广。
【关键词】 硬膜下血肿;引流;手术
Clinical analysis of the two different surgical methods for chronic subdural hematoma
CHEN Weifu,CHENG Yuan,MA Ying,et al.
(Department of Neurosurgery,Second Affiliated Hospital,Chongqing University of Medical Sciences,Chongqing 400010,China)
Abstract: Objective To explore the pathogenesis，clinical features and surgical management of chronic subdural hematoma (CSDH).Methods A retrospective study was performed on 316 patients with CSDH in the last 20 years , evaluating the clinical characteristics,radiological findings,complications,surgical results and comparison of the efficacy of two different surgical methods: burrhole drainage with soft channel system(10mm),and microhole drainage of closedhard channel system(2mm).Results 87.3% of the patients had good recovery，10.7% of the patients showed no change or worsened,1.9% of patients died.Compared with burrhole drainage with soft channel system(10mm),microhole drainage of closedhard channel system(2mm) had less compications and reoperation.Conclusion Compared with burrhole drainage of soft channel system,microhole drainage of closed-hard channel system with irrigation of the hematoma cavity is recommended.It is safe,efficient,less complications,timesaving,simple operation,suitable for various age groups.
Key words：subdural hematoma;drainage;operation
慢性硬脑膜下血肿(CSDH)是神经外科最常见的临床疾病之一，但有关CSDH产生和演变的机制至今不能诠释，临床上也缺乏统一的手术模式，再次手术率一直较高[1-4]。本文通过对我院1987年6月～2007年6月20年间前后不同阶段、采用不同手术方法治疗的316例CSDH患者临床资料进行回顾性分析，并从临床特征、影像学资料、术后并发症及预后等方面进行比较，旨在进一步探讨CSDH的发生机制与最佳的治疗策略，现报道如下。
临床资料
1 一般资料
本组共316例，男性247例，女性69例;年龄31～91岁，平均(66.6±13.6)岁。主要分布在60～69岁(77例，24.4%),70～79岁(109例,34.5%)年龄段。
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