目的:探討雙側慢性硬膜下血腫(BCSDH)的診斷和治療。方法:對25例老年患者BCSDH的診斷,治療資料總結分析,全部病例均行CT/或MRI檢查。所有患者皆行顱骨鉆孔引流術,其中5例單側鉆孔引流,20例雙側鉆孔引流。結果:全部病例均治愈,隨訪未見復發。結論:CT和MRI檢查是BCSDH的最佳診斷手段。鉆孔引流是BCSDH的有效治療方法。
目的:改良鉆孔引流術治療慢性硬膜下血腫27例,提高臨床治療效果。方法:術中可控下持續生理鹽水沖洗后,加入尼莫地平注射液排空,術后低滲或等滲液體維持腦灌注壓。結果:27例慢性硬膜下血腫經上述措施處理后,經隨訪均達到滿意臨床治療效果。結論:慢性硬膜下血腫鉆孔引流術中加用尼莫地平注射液沖洗、排氣,及規范化術后處理措施可提高臨床療效。
目的:探討外傷性硬膜下積液的治療經驗。方法:對 46例外傷性硬膜下積液患者的臨床資料進行回顧性分析。結果:非手術治療20例。手術治療30例次，其中腰蛛網膜下腔置管持續引流腦脊液5例，鉆孔外引流19例，骨窗開顱蛛網膜撕口4例，積液腔腹腔分流2例。結論:對外傷性硬膜下積液患者，應采取個性化的綜合治療方法。
ObjectiveTo explore the advantages and disadvantages of using two intracranial EEG (iEEG) monitoring methods—Subdural ectrodes electroencephalography (SDEG)and Stereoelectroencephalography (SEEG), in patients with “difficult to locate” Intractable Epilepsy. MethodsRetrospectively analyzed the data of 60 patients with SDEG monitoring (49 cases) and SEEG monitoring (11 cases) from January 2010 to December 2018 in the Department of Neurosurgery of the First Affiliated Hospital of Fujian Medical. Observe and statistically compare the differences in the evaluation results of epileptic zones, surgical efficacy and related complications of the two groups of patients, and review the relevant literature. ResultsThe results showed that the two groups of SDEG and SEEG had no significant difference in the positive rate and surgical resection rate of epileptogenic zones, but the bilateral implantation rate of SEEG (5/11, 45.5%) was higher than that of SDEG (18/49, 36.7%). At present, there was no significant difference in the postoperative outcome among patients with epileptic zones resected after SDEG and SEEG monitoring (P>0.05). However, due to the limitation of the number of SEEG cases, it is not yet possible to conclude that the two effects were the same. There was a statistically significant difference in the total incidence of serious complications of bleeding or infection between the two groups (SDEG 20 cases vs. SEEG 1 case, P<0.05). There was a statistically significant difference in the total incidence of significant headache or cerebral edema between the two groups (SDEG 26 cases vs. SEEG 2 cases, P<0.05). There was a statistically significant difference in the incidence of cerebrospinal fluid leakage, subcutaneous fluid incision, and poor healing of incision after epileptic resection (SDEG 14 cases vs. SEEG 0 case, P<0.05); there were no significant differences in dysfunction of speech, muscle strength between the two groups (P>0.05). ConclusionSEEG has fewer complications than SDEG, SEEG is safer than SDEG. The two kinds of iEEG monitoring methods have advantages in the localization of epileptogenic zones and the differentiation of functional areas. The effective combination of the two methods in the future may be more conducive to the location of epileptic zones and functional areas.
摘要:目的:探討老年慢性硬膜下血腫術后腦梗死的發病特點及防治措施。方法:總結分析21例老年慢性硬膜下血腫術后出現腦梗死患者。結果:多數患者具有高血壓、高血脂、冠心病及糖尿病等多個腦梗死高危因素。術后腦梗死發生于術后1周內者18例,其中3天以內者16例;腦梗死發生于手術區域附近者14例,非手術區域附近者7例,其中5例的腦梗死發生于上述兩個區域。結論:腦梗死發病的高危因素是顱腦術后腦梗死發生的主要原因。Abstract: Objective: To investigate and search for the causes of cerebral infarction after operation for subdural hematoma in senile patients and discuss the remedies for its prevention. Methods: Twentyone senile patients with cerebral infarction after operation for subdural hematoma were reviewed retrospectively. Results: Most of the patients were found to be suffered with several risk factors of cerebral infarction such as hypertension, coronary cardiac diseases, diabetes mellitus and so on. Eighteen cases of infarctions occurred within a week after operation, including 16 cases within 3 days. Fourteen cases of the infarctions located in regions around the operative field, while 7 cases in non operation related area, and 5 cases in both areas. Conclusions: Risk factors of cerebral infarction were the main causes to result in cerebral infarction after operation for subdural hematoma.
摘要:目的:探討慢性硬膜下血腫(chronic subdural hematoma, CSDH)鉆孔沖洗引流術后的復發因素。方法：回顧性分析165例CSDH鉆孔沖洗+閉式引流術的治療效果,并結合患者年齡、術后引流量、血腫腔是否有間隔、血腫厚度、引流管安放方向等因素進行相關分析。結果:本組治愈151例,血腫復發14例。〖HTH〗結論〖HTSS〗:患者年齡、術后引流量、血腫腔是否有間隔、血腫厚度、引流管安放方向是影響復發的主要因素。Abstract: Objective: To explore the related factors of recurrence of chronic subdural hematoma after burr hole drainage.Methods:The related aspects that affected the recurrence in 165 cases with chronic subdural hematomas after burr hole drainage were reviewed,and patient’s age,drainage volume,thickness of hematoma, septal hematoma cavity and direction of drain pipe were evaluated.Results:Clinical outcomes were satisfactory.151 patients completely recovered after burr hole drainage,there were 14 patients with hematoma recurrence. Conclusion : Age, drainage volume, thickness of hematoma, septal hematoma cavity and direction of drain pipe would affect the prognosis.