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Experience in Diagnosis and Treatment of Chronic Subdural Hematoma

目的:探讨慢性硬膜下血肿的临床及诊疗要点。方法:回顾性分析138例慢性硬膜下血肿患者的临床资料。结果:1例术中大出血死亡,其余137例均治愈出院。术后硬膜下积液2例,脑内血肿5例,张力性气颅2例,癫痫发作3例,3例复发。结论:头颅CT平扫是诊断CSDH的首选检查。对于有症状的CSDH患者,应根据血肿的特点,选择合适的术式,而积极防治手术并发症是治疗CSDH的关键。

The influence of diabetes on aortic intramural hematoma recovery

目的 探讨糖尿病对主动脉壁内血肿的预后影响。 方法 纳入 2012 年 10 月至 2014 年 11 月我院连续 24 例主动脉壁内血肿患者，其中男 17 例、女 7 例，年龄（58.83±10.42）岁，定期复查主动脉 CTA（复查时间为 3～4 周），观察糖尿病患者和非糖尿病患者主动脉壁内血肿的进展情况。 结果 24 例患者在复查时，出现 A 型主动脉夹层 2 例，B 型主动脉夹层 3 例（均为腹部局限性夹层）；4 例患者合并糖尿病，复查时 2 例进展为主动脉夹层，2 例血肿及溃疡加重。 结论 主动脉壁内血肿整体呈吸收趋势，无并发症发生。手术事件的发生率与患者合并糖尿病有密切关系。

慢性硬膜下血肿钻孔引流术中冲洗与不冲洗疗效对比研究

目的对比分析慢性硬膜下血肿钻孔引流术中冲洗与不冲洗不同手术操作方法对患者术后疗效及并发症的影响。 方法回顾性收集 2013 年 1 月—2014 年 12 月在四川大学华西医院神经外科就诊的 81 例单侧慢性硬膜下血肿患者临床及影像学资料，患者分别采用钻孔引流+术中生理盐水彻底冲洗+术后引流治疗（冲洗组 46 例）及钻孔置管引流不行冲洗治疗（引流组 35 例），应用 3D-Slicer 软件精确测量术后 1 d 颅内积气量及出院残余血肿量，对测量数据及并发症发生情况进行对比分析，并利用术后门诊随访及电话随访资料对比分析血肿复发情况。 结果术后第 2 天冲洗组与引流组患者颅内积气量分别为（9.98±4.73）、（3.78±1.80）mL，差异有统计学意义（P<0.05）；冲洗组与引流组术后发生新鲜出血概率分别为 6.5%、2.9%，出院前残余血肿量分别为（9.82±3.20）、（10.94±4.34）mL，血肿复发率分别为 6.5%、8.6%，差异均无统计学意义（P>0.05）。 结论钻孔引流术中冲洗能快速引流出硬膜下血肿，但明显增加术后颅内积气，并可能增加出血风险，且远期疗效与不冲洗组相比无明显差异，故钻孔引流无需术中冲洗。由于样本量及设计学缺陷，尚需大规模随机对照试验作进一步验证。

Clinical Study of Effects of the Small Dural Window Exposure Strategy to Prevent Intraoperative Acute Encephalocele during Traumatic Intracranial Hematoma Evacuation

目的:探讨对合并脑疝形成的外伤性颅内血肿患者进行小硬脑膜窗口显露预防急性脑膨出的临床价值。方法:收集我院2005年1月至2007年1月收治符合标准的合并脑疝形成的外伤性颅内血肿患者126例,均行开颅去大骨瓣减压手术,治疗组67例行小硬脑膜窗口显露的方式进行血肿清除术,对照组59例采用传统的硬脑膜切开进行清除血肿清除术。结果:治疗组患者颅内压下降速度和程度优于对照组(Plt;0.05),治疗组术中急性脑膨出的发生率低于对照组(Plt;0.05)。结论:小硬脑膜窗口显露是预防急性脑膨出发生的一种有效手术方式。

Clinical efficacy of single branch stent-graft treatment for retrograde type A intramural hematoma: A retrospective cohort study

ObjectiveTo explore the efficacy of using a single branch stent-graft to treat primary intramural hematoma located at the distal arch or descending aorta in Stanford A type aortic intramural hematoma. MethodsFrom July 2020 to November 2022, 10 patients with primary intramural hematoma of Stanford A type aortic intramural hematoma were treated with endovascular repair using a single branch stent-graft in the Department of Cardiovascular Surgery at The University of Hong Kong-Shenzhen Hospital. There were 9 males and 1 female, aged from 32 to 66 years, with a mean age of (47.0±10.4) years. All patients had intramural hematoma involving the ascending aorta and aortic arch, diagnosed as type A intramural hematoma, with the tear located in the descending aorta. Among them, 6 patients were complicated by ulceration of the descending aorta with intramural hematoma, and 4 patients had changes of the descending aortic dissection. All patients underwent endovascular stent repair, with 8 patients undergoing emergency surgery (≤14 days) and 2 patients undergoing subacute surgery (15 days to 3 months). Results There were no neurological complications, paraplegia, stent fracture or displacement, or limb or visceral ischemia during the perioperative period in all patients. One patient had continuous chest pain after surgery, and the stent had a new tear at the proximal end, requiring ascending aorta and partial arch replacement. As of the latest follow-up, all patients had obvious absorption or complete absorption of the intramural hematoma in the ascending aorta and aortic arch compared with before the operation. ConclusionSingle branch stent-graft treatment of retrograde ascending aortic intramural hematoma is safe and effective, with good short-term results.

强直性脊柱炎伴颈椎硬膜外血肿的诊治

目的总结强直性脊柱炎伴颈椎硬膜外血肿的特点和诊治方法。 方法1994年1月－2009年2月，收治4例外力作用后发生颈椎硬膜外血肿的强直性脊柱炎男性患者。年龄56～67岁，平均62.8岁。出现症状至入院时间为8 h～5 d，平均46 h。Frankel分级：B级2例，C级2例。MRI检查示硬膜外血肿位于C3～T2。1例行颈椎后路手术；2例并发Ⅱ型呼吸衰竭及1例并发高血压、劳力型心绞痛者，行保守治疗。 结果手术治疗患者术后切口Ⅰ期愈合，获随访14个月，感觉平面由C6下降至C8，双上肢肌力较术前增加1级，双下肢肌力较术前无改善；Frankel分级为B级。保守治疗患者中，1例并发Ⅱ型呼吸衰竭者死亡；其余2例患者分别获随访12、18个月，感觉平面、双上下肢肌力及Frankel分级与治疗前比较均无改善。 结论颈椎硬膜外血肿是强直性脊柱炎的少见并发症，多由轻微过伸伤引起，常迟发性出现临床症状，MRI是首选诊断方法，预后较差。

Applied analysis of plasma tube in prevention of scrotal hematoma after inguinal hernia

Objective To investigate the value of applying closed continuous negative pressure drainage in preventing postoperative complications of inguinal hernia. Methods The clinical data of 107 adult male patients diagnosed with inguinal giant hernia (incarcerated 16 cases, non-incarcerated 91 cases) undergoing tension-free hernioplasty using the Ultrapro Hernia System (UHS) between April 2011 and June 2016 in our hospital were retrospective analyzed. Prophylactic use of antibiotics was not adopted except patients with incarcerated hernia, diabetes, or elderly. Multi-lateral hole plasma drainage tube were used in 61 patients, 46 cases without indwelling plasma tube. The postoperative scrotum pain, scrotal hematoma, scrotal effusion, and incision infection of two groups patients were observed. Results Of the 61 patients with plasma drainage, the mean drainage time was 2 days, the longest was 5 days. Postoperative scrotal pain was found in 2 cases (3.3%) without scrotal hematoma or scrotal effusion. Of the 2 patients, the drainage of 1 case was obstructed, the drainage was extubated and the patient was cured and discharged after 5 days by sucking the drainage tube using empty needle. The average hospital stay in this group was 4 days. Of the 46 patients without plasma drainage, 7 patients (15.2%) suffered scrotal pain, 7 patients (15.2%) suffered scrotal hematoma. The average hospital stay was 6 days. The incidence of scrotal pain and scrotal hematoma was significantly higher in patients without plasma drainage than those with drainage (P<0.05). The condition of scrotal hematoma would be improved after 1–3 times outpatient dressing change and repeated hematoma sucking. One case was not improved after repeated suction, the condition was improved after scrotum incision, drainage, and dressing. Conclusion Closed continuous negative pressure drainage potentially prevents oblique hernia pain and scrotal hematoma without increasing the incidence of incision infection or hospitalization time.

创伤性纵隔血肿的特点及处理

目的 探讨创伤性纵隔血肿的临床特征、诊断方法和治疗.方法 对12例纵隔血肿病例进行了总结,对其临床表现、治疗方法、疗效和预后进行了分析.结果 486例胸部创伤患者中发生纵隔血肿12例,占胸部创伤的2.5%.根据病情进行开胸手术及B型超声波定位引导下血肿穿刺治疗,治愈11例,死亡1例.结论 严重胸部创伤时,即使无明显临床症状,亦应考虑纵隔血肿的存在,并给予必要的检查,积极治疗,效果满意.

介入治疗盆部外伤性巨大血肿一例

新生儿颅骨骨膜下血肿骨化临床CT分析

目的探讨新生儿颅骨骨膜下血肿的临床特点、CT影像变化及转归。 方法回顾性分析2008年2月－2012年8月收治的15例经产道自然分娩所致新生儿颅骨骨膜下血肿骨化的临床特点、CT表现及其治疗。 结果15例新生儿颅骨骨膜下血肿均有头盆不称、胎位不正或器械助产史，左或右侧顶部隆起质硬包块，基底部范围4.5～7.6 cm，病程4周～3个月，期间未经任何治疗处理；CT表现12例呈“夹心饼征”样之双层颅板表现，3例血肿下颅骨内外板全层骨质部分吸收消失，骨膜下新生骨有替代颅骨形成新颅骨的趋势。 结论新生儿颅骨骨膜下血肿大部分可自行吸收消散；4周后不能缩小消散，且基底部直径＞4.5 cm的血肿易骨化，需及时治疗处理，避免形成头颅畸形，错过最佳治疗时机，增加治疗难度。