Clinical Analysis Of Surgical Treatment In 321 Patients With Chronic Subdural Hematoma

Objective:To explore the efficacy of surgical treatment in chronic subdural hematoma(CSDH),the epidemiological characteristics,influencing factors of surgical efficacy and recurrence of chronic subdural hematoma,were analyzed and summarized,which provided valuable reference for the treatment of chronic subdural hematoma.Methods:A retrospective analysis of 321 patients with chronic subdural hematoma treated mainly by surgery in Taizhou people’s Hospital from August 2015 to August 2020 was conducted,according to the patient’s age,sex,history of trauma,use of anticoagulants,main symptoms,complications(hypertension and diabetes),preoperative GCS score,preoperative ADL score,preoperative hematoma volume,hematoma density,hematoma separation,anesthesia,operation,postoperative drainage tube head orientation,postoperative symptom relief,postoperative GCS score and ADL score,postoperative complications,The absorption of hematoma before discharge and the recurrence after operation were statistically analyzed.We summarized the epidemiological characteristics of chronic subdural hematoma were summarized,and analyzed the curative effect of surgical treatment of chronic subdural hematoma was analyzed,as well as the postoperative complications and independent factors affecting postoperative recurrence were analyzed.Results : Among the 321 patients included,there were 263 males(81.9%)and 58females(18.1%)with male-to-female ratio about 4.5%,aging from14 to 94 years old(average(68.0 ±12.4)years old),including 210 cases(65.4%,≥ 65 years old)and 111 cases(34.6%,< 65 years old).Cases of patients with a clear history of trauma are168(52.3%).Cases of patients without a clear history of trauma are 153(47.7%).Cases of oral anticoagulants or antiplatelet drugs are 11(3.4%).The unilateral / bilateral ratio was 258 / 63.The main clinical symptoms with headache are 180 cases(56.1%),with limb weakness are 146 cases(45.5),and with dizziness are 135 cases(42.1%).The total effective rate(263 cases)of the operation was81.9%,and the mortality rate was 1.3%.Univariate analysis showed that compared with the patients with poor curative effect,the average age of the total effective patients was relatively younger [(71.9±10.6)years old,(67.2±12.7)years old],fewer patients with hypertension(49.1% vs 24.0%),fewer patients with preoperative GCS score less than 15(27.6% vs 14.8%),and fewer patients with preoperative ADL score of 0-60(47.3% vs 27.4%).There were relatively more patients with preoperative ADL score of 61-99(21.8%,38.0% respectively),lower proportion of hard channel drilling and drainage(12.1% vs 1.1%),and lower proportion of standard craniotomy(5.2%,0.4% respectively).The difference was statistically significant(all P < 0.05).Multivariate logistic regression analysis showed that preoperative hypertension(OR=0.382,95%CI:0.201～0.726,P=0.003),preoperative ADL score(OR=0.327,95%CI:0.136～0.788,P=0.013)and mode of operation(OR=9.303,95%CI:2.086～41.485,P=0.003)were independent factors affecting the efficacy of chronic subdural hematoma.Preoperative hematoma septal cavity(OR=0.232,95%CI:0.063～0.853,P=0.028)and mode of operation(OR=0.084,95%CI:0.020～0.344,P=0.001)are independent factors affecting the recurrence of chronic subdural hematoma.The orientation of drainage tube(OR=10.582,95%CI:3.128～35.796,P < 0.001)and preoperative ADL score(OR=2.023,95%CI:1.080～3.788,P=0.028)were independent factors affecting postoperative intracranial gas accumulation.The surgery of drilling and drainage is a relatively reliable method for the treatment of chronic subdural hematoma.The separate cavity of hematoma is an independent risk factor for recurrence.Endoscope-assisted drilling and drainage may reduce the recurrence rate,while hard channel drilling and drainage may be more prone to recurrence and with poor curative effect.Standard craniotomy is mainly used for patients with recurrence or severe organization of hematoma after drilling and drainage.Conclusion:Chronic subdural hematoma often occurs in the elderly,and the incidence of chronic subdural hematoma increases gradually due to the aging of the population.The surgery of drilling and drainage is a relatively reliable method for the treatment of chronic subdural hematoma.Preoperative hypertension and low preoperative ADL score are important factors affecting the curative effect of operation.Postoperative intracranial gas accumulation affects the reexpansion of brain tissue,while the postoperative drainage tube facing the forehead can fully improve intracranial gas accumulation.