作者：曹育嘉，高山，吴建东

单位：

1.215129江苏省苏州市，苏州高新区人民医院神经外科　 2.215129江苏省苏州市立医院神经外科 通信作者：吴建东，E-mail：13952242122@163.com

Units：

1.Department of Neurosurgery, the People's Hospital of SND, Suzhou 215129, China 2.Department of Neurosurgery, Suzhou Municipal Hospital, Suzhou 215129, China Corresponding author: WU Jiandong, E-mail: 13952242122@163.com

关键词：

血肿,硬膜下,慢性; 硬通道钻孔引流术; 脑膜中动脉栓塞术;

Keywords：

Hematoma, subdural, chronic; Hard channel drilling and drainage; Middle meningeal artery embolization

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.260

Funds：

苏州市科技计划项目（SYS2020181）

摘要：

目的 探讨硬通道钻孔引流术联合脑膜中动脉栓塞术治疗慢性硬膜下血肿的效果。方法 回顾性选取2020年1月至2021年5月苏州高新区人民医院收治的接受硬通道钻孔引流术联合脑膜中动脉栓塞术治疗的慢性硬膜下血肿患者20例，收集患者一般资料、手术策略、手术效果、手术相关并发症及术后3个月复发、预后情况。结果 患者年龄39～88岁，平均(72.5±12.8)岁；男14例，女6例；15例合并基础疾病；4例有阿司匹林使用史，1例有华法林使用史；17例有头部外伤史，3例否认有头部外伤史；单侧发病16例，双侧发病4例；8例仅表现为头痛头晕，12例合并神经功能障碍。16例单侧发病患者采用单侧硬通道钻孔引流术联合单侧脑膜中动脉栓塞术治疗，3例双侧发病患者(以单侧为主)采用最大血肿侧硬通道钻孔引流术联合双侧脑膜中动脉栓塞术治疗，1例双侧发病患者采用双侧硬通道钻孔引流术联合双侧脑膜中动脉栓塞术治疗；12例患者血肿有效清除，17例患者中线有效回归；2例发生穿刺点血肿，5例发生坠积性肺炎。术后3个月，16例患者预后良好，2例患者出院后呈重残状态，2例患者复发。结论 慢性硬膜下血肿患者采用硬通道钻孔引流术联合脑膜中动脉栓塞术治疗后复发率为10.0%，多数患者预后良好。

Abstract：

【Abstract】　Objective To investigate the effect of hard channel drilling and drainage combined with middle meningeal artery embolization in the treatment of chronic subdural hematoma. Methods Twenty patients with chronic subdural hematoma who received hard channel drilling and drainage combined with middle meningeal artery embolization in the People's Hospital of SND from January 2020 to May 2021 were retrospectively selected. The general data, surgical strategy, surgical effect, surgery-related complications, and recurrence and prognosis 3 months after surgery were collected. Results The age of the patients ranged from 39 to 88 years old, with an average of (72.5±12.8) years old; there were 14 males and 6 females; 15 patients had chronic underlying disease; 4 cases had a history of oral aspirin, 1 case had a history of oral warfarin; 17 cases had a history of head trauma, and 3 cases denied head trauma history; 16 cases were unilateral and 4 cases were bilateral; 8 cases only presented with headache and dizziness, and 12 cases had neurological dysfunction. Sixteen patients with unilateral disease were treated with unilateral hard channel drilling and drainage combined with unilateral middle meningeal artery embolization, and 3 patients with bilateral disease (mainly unilateral) were treated with hard channel drilling and drainage on the side of the largest hematoma combined with bilateral middle meningeal artery embolization, 1 patient with bilateral disease was treated with bilateral hard channel drilling and drainage combined with bilateral middle meningeal artery embolization. Hematoma was effectively cleared in 16 cases, and the midline was effectively returned in 17 cases. Two cases occurred puncture point hematoma and 5 cases occurred hypostatic pneumonia. Three months after the surgery, 16 patients had good prognosis, 2 patients had severe disability after discharge, 2 patients recurred. Conclusion The recurrence rate of patients with chronic subdural hematoma treated with hard channel drilling and drainage combined with middle meningeal artery embolization is 10.0%, and most patients have a good prognosis.

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