Tsai Tai-Hsin, Lieu Ann-Shung, Hwang Shiuh-Lin, Huang Tzuu-Yuan, Hwang Yan-Fen
Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
J Trauma. 2010 Mar;68(3):571-5. doi: 10.1097/TA.0b013e3181a5f31c.
: Chronic subdural hematoma (CSDH) is a relatively frequent problem in neurologic or neurosurgical practice. Although CSDH is a well-known disease, data on bilateral CSDH are scarce compared with data on unilateral CSDH. The purpose of this study was to compare the clinical presentations, precipitating factors, computed tomography (CT) scan findings, postoperative complications, and outcomes between patients with bilateral and unilateral CSDH.
: A retrospective study was performed on 129 surgical patients with CSDH from January 2002 to January 2005. These patients were divided into two groups: bilateral CSDH (45 cases) and unilateral CSDH (84 cases). Clinical presentations, precipitating factors, CT scan findings, postoperative complications, and outcomes of patients were analyzed.
: The mean age was 75 years for patients with bilateral CSDH and was 68 years for patients with unilateral CSDH (p = 0.696). Males predominated in each group (p = 0.696). The frequency of presenting symptoms of nausea and vomiting, headache, or unsteady gait was significantly greater in bilateral CSDH than in unilateral CSDH (p < 0.05). The incidence of usage of anticoagulant and antiplatelet therapy was significantly higher in bilateral CSDH group than in unilateral CSDH group (p < 0.05). The frequency of marked midline shift on CT scans was significantly greater in unilateral CSDH than in bilateral CSDH (p < 0.05). Coexisting systemic diseases, postoperative complications, and outcomes had no significant differences between both groups.
: Bilateral CSDH tended to occur more in patients with anticoagulant or antiplatelet therapy. Compared with patients with unilateral CSDH, patients with bilateral CSDH had more symptoms of increased intracranial pressure and lower incidences of midline shift on CT scans. Most patients with either bilateral or unilateral CSDH had a good postoperative outcome.
慢性硬膜下血肿（CSDH）是神经科或神经外科实践中较为常见的问题。尽管CSDH是一种众所周知的疾病，但与单侧CSDH的数据相比，双侧CSDH的数据较少。本研究的目的是比较双侧和单侧CSDH患者的临床表现、诱发因素、计算机断层扫描（CT）扫描结果、术后并发症及预后。
对2002年1月至2005年1月期间129例接受手术治疗的CSDH患者进行回顾性研究。这些患者被分为两组：双侧CSDH（45例）和单侧CSDH（84例）。分析患者的临床表现、诱发因素、CT扫描结果、术后并发症及预后。
双侧CSDH患者的平均年龄为75岁，单侧CSDH患者的平均年龄为68岁（p = 0.696）。每组中男性居多（p = 0.696）。双侧CSDH患者出现恶心呕吐、头痛或步态不稳等症状的频率明显高于单侧CSDH患者（p < 0.05）。双侧CSDH组抗凝和抗血小板治疗的使用率明显高于单侧CSDH组（p < 0.05）。CT扫描显示单侧CSDH中线明显移位的频率明显高于双侧CSDH（p < 图05）。两组患者并存的全身疾病、术后并发症及预后无显著差异。
双侧CSDH在接受抗凝或抗血小板治疗的患者中更易发生。与单侧CSDH患者相比，双侧CSDH患者颅内压升高症状更多，CT扫描中线移位发生率更低。大多数双侧或单侧CSDH患者术后预后良好。
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