双侧慢性硬脑膜下血肿的临床特点及治疗方式

目的探讨双侧慢性硬脑膜下血肿的临床特点以及治疗方法。方法收集443例慢性硬脑膜下血肿患者，根据影像学检查结果将患者分为单侧慢性硬脑膜下血肿组（单侧血肿组，340例）和双侧慢性硬脑膜下血肿组（双侧血肿组，103例）；双侧血肿组患者又按手术方式分为双侧钻颅组（65例）与单侧钻颅组（38例）。对比分析各组患者的临床资料。结果双侧血肿组与单侧血肿组患者的年龄差异无统计学意义（P＞0.05）。双侧血肿组患者男性（90.29%）、头部外伤史（82.52%）的比例明显高于单侧血肿组（81.47%，64.41%）；出现症状-就诊时间短于单侧组，肢体无力、精神症状的比例低于单侧组，头痛、恶心症状的比例高于单侧组；差异均有统计学意义（均P≤0.05）。双侧血肿单侧钻孔组患者再次手术的比例明显高于双侧钻孔组（P≤0.01），两组患者术后并发症的差异无统计学意义（P＞0.05）。结论与单侧慢性硬膜下血肿患者相比，双侧血肿患者更加具备慢性硬膜下血肿的特征性。采用双侧钻颅手术治疗，有助于减少双侧慢性硬膜下血肿的再次手术率，从而改善患者的预后，降低治疗费用。

Abstract: Objective To investigate the clinical characteristics and treatment of bilateral chronic subdural hematoma（CSDH）. Methods 443 patients with CSDH were collected. According to the imaging results, the patients were divided into unilateral CSDH group(340 cases) and bilateral CSDH group(103 cases); The patients in the bilateral hematoma group were divided into bilateral cranial drainage group(65 cases) and unilateral cranial drainage group(38 cases). The clinical data of patients in each group were compared and analyzed. Results There was no significant difference in age between bilateral hematoma group and unilateral hematoma group(P>0.05). The proportion of male(90.29%) and head trauma history(82.52%) in bilateral hematoma group was significantly higher than that in unilateral hematoma group(81.47%, 64.41%). Time between having symptoms and treatment was shorter than that in the unilateral group, the proportion of limb weakness and mental symptoms was lower than that in the unilateral group, and the proportion of headache and nausea was higher than that in the unilateral group; The difference was statistically significant(all P≤0.05). The proportion of reoperation in bilateral hematoma unilateral drainage group was significantly higher than that in bilateral drainage group(P≤0.01). There was no significant difference in postoperative complications between the two groups(P>0.05). Conclusions Compared with patients with unilateral CSDH, patients with bilateral hematoma have more characteristics of CSDH. Bilateral craniotomy is helpful to reduce the reoperation rate of bilateral CSDH, so as to improve the prognosis and reduce the treatment cost.