本文選題：慢性硬膜下血腫　切入點(diǎn)：微孔導(dǎo)管浣洗術(shù)　出處：《河北醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:慢性硬膜下血腫是神經(jīng)外科常見病,治療以外科手術(shù)為主,現(xiàn)在外科手術(shù)越來越微創(chuàng)化、精細(xì)化�，F(xiàn)在介紹一種新的慢性硬膜下血腫治療方法-微孔導(dǎo)管浣洗術(shù),并討論其特點(diǎn)及療效。方法:回顧性分析我院自2009年2月至2014年12月間128例慢性硬膜下血腫行穿刺手術(shù)患者。將128例患者分成兩組,實(shí)驗(yàn)組和對(duì)照組,其中實(shí)驗(yàn)組86例患者行微孔導(dǎo)管浣洗術(shù),對(duì)照組42例患者行YL-1硬通道穿刺引流術(shù)。兩組在年齡、性別、有無基礎(chǔ)病及血腫大小等方面無統(tǒng)計(jì)學(xué)差異。實(shí)驗(yàn)組男性76例,女性10例;年齡35~90歲,平均71.7歲,單側(cè)血腫73例,雙側(cè)血腫13例,共計(jì)99側(cè)血腫,有明確頭外傷史69例。86例全部行微孔導(dǎo)管浣洗術(shù)。術(shù)后保留引流管,間斷抽吸浣洗血腫,復(fù)查頭顱CT,據(jù)CT結(jié)果適時(shí)拔管。一般引流管留置2~3天,沖洗2~3次。術(shù)后據(jù)改良Markwalder的CSDH評(píng)分評(píng)估治療效果。對(duì)照組男性36例,女性6例;年齡36~88歲,平均70.6歲,單側(cè)血腫35例,雙側(cè)血腫7例,共計(jì)49側(cè)血腫,有明確頭外傷史28例。42例全部行YL-1硬通道穿刺引流術(shù)。術(shù)后接引流袋持續(xù)頭低位引流,可間斷沖洗,復(fù)查頭顱CT,據(jù)CT結(jié)果適時(shí)拔管。一般引流管留置3~4天,沖洗2~3次。術(shù)后據(jù)改良Markwalder的CSDH評(píng)分評(píng)估治療效果。結(jié)果:實(shí)驗(yàn)組術(shù)后一次性治愈78例(90.7%),好轉(zhuǎn)8例(9.3%),總有效率100%,其中血腫復(fù)發(fā)4例(4.6%),顱內(nèi)感染0例,術(shù)后發(fā)生硬膜外血腫1例(1.1%),張力性氣顱0例。對(duì)照組術(shù)后一次性治愈28例(66.7%),好轉(zhuǎn)9例(21.4%),總有效率88%,其中血腫復(fù)發(fā)8例(19%),顱內(nèi)感染2例(4.7%),術(shù)后發(fā)生硬膜外血腫3例(7.1%),顱內(nèi)血腫2例(4.7%),張力性氣顱17例(40.4%)。結(jié)論:慢性硬膜下血腫微創(chuàng)手術(shù)治療與傳統(tǒng)微創(chuàng)方式相比微孔導(dǎo)管浣洗術(shù)具有創(chuàng)傷小,操作簡(jiǎn)單,易推廣,且病死率低,并發(fā)癥少,恢復(fù)快的優(yōu)點(diǎn),對(duì)慢性硬膜下血腫病人是一種較理想的微創(chuàng)手術(shù)方式。
[Abstract]:Objective: chronic subdural hematoma is a common neurosurgical disease.This paper introduces a new treatment method of chronic subdural hematoma, micropore catheter washing, and discusses its characteristics and curative effect.There was no significant difference in age, sex, basic disease and hematoma size between the two groups.There were 76 males and 10 females in the experimental group, age 3590 years (mean 71.7 years), unilateral hematoma 73 cases, bilateral hematoma 13 cases, a total of 99 side hematoma. 69 cases (86 cases) with definite history of head trauma were washed by microcatheter.After operation, the drainage tube was retained, the hematoma was washed by intermittent aspiration, and CTT was rechecked. The catheter was removed timely according to the CT results.General drainage tube indwelling for 2 days, flushing 2 times 3 times.The therapeutic effect was evaluated by modified Markwalder CSDH score after operation.The control group consisted of 36 males and 6 females, aged 36 88 years (mean 70.6 years), 35 unilateral hematoma and 7 bilateral hematoma, with a total of 49 hematomas. 28 cases with definite history of head trauma were treated with YL-1 hard channel puncture drainage.Continuous head-low drainage with drainage bag after operation, intermittent washing, reexamination of head CTs, timely extubation according to CT results.General drainage tube indwelling for 3 days, flushing 2 times 3 times.The therapeutic effect was evaluated by modified Markwalder CSDH score after operation.Results: in the experimental group, 78 cases were cured at one time, 9. 3 were improved in 8 cases, the total effective rate was 100, including 4 cases of hematoma recurrence, 4 cases of intracranial infection, 1 case of epidural hematoma and 1 case of tension pneumocranium.Conclusion: compared with the traditional minimally invasive treatment of chronic subdural hematoma, microcatheter washing has the advantages of less trauma, simple operation, easy popularization, low mortality, less complications and quick recovery.It is an ideal minimally invasive operation for patients with chronic subdural hematoma.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R651.15

【參考文獻(xiàn)】

相關(guān)期刊論文 前9條

1 楊國(guó)瑛;王學(xué)富;張文彬;樊保華;;不同手術(shù)方法治療慢性硬膜下血腫的療效分析(附139例病例分析)[J];安徽醫(yī)學(xué);2011年12期

2 張敏新;;微創(chuàng)穿刺術(shù)與鉆孔引流術(shù)治療慢性硬膜下血腫的療效評(píng)價(jià)[J];河南科技大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2011年01期

3 鄭偉武;田飛;陳文榮;張?jiān)隽?楊少鋒;趙澤林;;慢性硬膜下血腫132例病例分析[J];臨床和實(shí)驗(yàn)醫(yī)學(xué)雜志;2006年07期

4 王光弟,夏吉勇,馬驥超,艾泉山;老年人慢性硬膜下血腫的微創(chuàng)治療[J];中華老年多器官疾病雜志;2004年04期

5 高乃康,毛伯鏞;慢性硬膜下血腫治療及其復(fù)發(fā)相關(guān)因素研究[J];中華神經(jīng)外科疾病研究雜志;2004年04期

6 錢志遠(yuǎn),蘭青,黃強(qiáng),陳堅(jiān),陸朝暉;年輕人慢性硬膜下血腫鉆孔引流治療[J];中華神經(jīng)外科疾病研究雜志;2003年03期

7 程化坤,高宏偉,青松文,趙洪波,賈建式,張鵬儒;慢性硬膜下血腫形成機(jī)理的電鏡觀察[J];中華神經(jīng)外科雜志;1999年02期

8 劉崢,陳宏頡,張錫增,戴秋生,王如密,鄭兆聰,李登錦,陳蘇;錐顱引流治療慢性硬膜下血腫失敗的臨床分析[J];中華神經(jīng)外科雜志;1999年01期

9 李獻(xiàn)福;影響慢性硬腦膜下血腫術(shù)后吸收的因素[J];國(guó)外醫(yī)學(xué).神經(jīng)病學(xué)神經(jīng)外科學(xué)分冊(cè);1990年01期

，

本文編號(hào)：1719152