Yu Guang Jie, Han Chong Zhen, Zhang Ming, Zhuang Han Ting, Jiang Yong Gang
Department of Neurosurgery, Qingdao Haici Hospital, P.R. China.
Br J Neurosurg. 2009 Dec;23(6):606-11. doi: 10.3109/02688690903386983.
Recurrence of chronic subdural hematoma (CSH) is a significant problem in neurosurgical practice. Various risk factors associated with patient's characteristics and the pathogenesis of CSH have been investigated in many studies, but controversial findings are not uncommon. Therefore we made a retrospectively investigation focusing mainly on the factors associated with surgical techniques. in order to find out the factors that may affect the recurrence rate of CSH. The medical records of 97 consecutive patients with 121 CSHs, who were treated with burr-hole craniostomy and continuous drainage, were retrospectively reviewed. The relationships between the recurrence rate and some factors associated with surgery, such as location of burr-hole, thickness of residual hematoma, location of drainage catheter, intracapsular air postsurgery, duration of drainage were investigated. The average recurrence rate was 6.6% in this whole series. For patients with less than three days of drainage, the recurrence rate was 16.3%, whereas for those with 3 and more days of drainage, the recurrence rate was only 1.3%. The duration of drainage significantly related to recurrence rate. In addition, a higher recurrence rate seemed to be associated with more intracapsular air postsurgery, but it did not reach statistically significant level in this study. Prolonged duration of drainage did not increase the frequency of infection in this series. We found in this study that the duration of drainage play an important role in the treatment of CSH and 3 full days of drainage seems to be necessary, especially for patients of 60 years and over. We presumed that it takes at least 3 days of drainage for outer membrane of CSH to get the restoration of a normal balance between coagulation and fibrinolysis after surgery, which is necessary for termination of the vicious cycle and resolution of the hematoma.
慢性硬膜下血肿（CSH）的复发是神经外科实践中的一个重要问题。许多研究已经调查了与患者特征和CSH发病机制相关的各种危险因素，但有争议的发现并不少见。因此，我们进行了一项回顾性研究，主要关注与手术技术相关的因素，以找出可能影响CSH复发率的因素。回顾性分析了97例连续121例CSH患者的病历资料，这些患者均接受了钻孔引流术。研究了复发率与一些手术相关因素之间的关系，如钻孔位置、残余血肿厚度、引流管位置、术后囊内积气、引流时间等。本系列患者平均复发率为6.6%。引流时间少于3天的患者复发率为16.3%，而引流时间为3天及以上的患者复发率仅为1.3%。引流时间与复发率显著相关。此外，术后囊内积气较多似乎与较高的复发率相关，但在本研究中未达到统计学显著水平。在本系列中，延长引流时间并未增加感染频率。我们在本研究中发现，引流时间在CSH治疗中起重要作用，3天的充分引流似乎是必要的，尤其是对于60岁及以上的患者。我们推测，CSH外膜至少需要3天的引流时间才能在术后恢复凝血和纤维蛋白溶解之间的正常平衡，这对于终止恶性循环和血肿消退是必要的。
