Takayama Motoharu, Terui Keita, Oiwa Yoshitsugu
Department of Surgical Neurology, Ibukino Hospital, Osaka, Japan.
No Shinkei Geka. 2012 Oct;40(10):871-6.
Chronic subdural hematoma is common in elderly individuals and surgical procedures are simple. The recurrence rate of chronic subdural hematoma, however, varies from 9.2 to 26.5% after surgery. The authors studied factors of the recurrence using univariate and multivariate analyses in patients with chronic subdural hematoma
We retrospectively reviewed 239 consecutive cases of chronic subdural hematoma who received burr-hole surgery with irrigation and closed-system drainage. We analyzed the relationships between recurrence of chronic subdural hematoma and factors such as sex, age, laterality, bleeding tendency, other complicated diseases, density on CT, volume of the hematoma, residual air in the hematoma cavity, use of artificial cerebrospinal fluid.
Twenty-one patients (8.8%) experienced a recurrence of chronic subdural hematoma. Multiple logistic regression found that the recurrence rate was higher in patients with a large volume of the residual air, and was lower in patients using artificial cerebrospinal fluid. No statistical differences were found in bleeding tendency.
Techniques to reduce the air in the hematoma cavity are important for good outcome in surgery of chronic subdural hematoma. Also, the use of artificial cerebrospinal fluid reduces recurrence of chronic subdural hematoma. The surgical procedures can be the same for patients with bleeding tendencies.
慢性硬膜下血肿在老年人中很常见，手术操作简单。然而，慢性硬膜下血肿术后复发率在9.2%至26.5%之间。作者采用单因素和多因素分析研究慢性硬膜下血肿患者复发的因素。
我们回顾性分析了239例连续接受钻孔冲洗闭式引流手术的慢性硬膜下血肿患者。我们分析了慢性硬膜下血肿复发与性别、年龄、血肿部位、出血倾向、其他合并疾病、CT密度、血肿体积、血肿腔内残留气体、使用人工脑脊液等因素之间的关系。
21例患者（8.8%）出现慢性硬膜下血肿复发。多因素logistic回归分析发现，残留气体量大的患者复发率较高，而使用人工脑脊液的患者复发率较低。出血倾向方面未发现统计学差异。
减少血肿腔内气体的技术对于慢性硬膜下血肿手术的良好预后很重要。此外，使用人工脑脊液可降低慢性硬膜下血肿的复发率。对于有出血倾向的患者，手术操作可以相同。
