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。
目的：比较脑内血肿体积不同测量方法，为损伤程度鉴定提供更适用的依据。方法:将已知体积的模拟血肿经过CT扫描，用不同的测量方法测量其体积然后进行比较。结果：经统计学处理，CT 定量、体视学法、尺量法测得的体积与模拟血肿体积无显著差异，多田法测出的体积与模拟血肿体积有显著差异。结论：在司法实践中，体视法为测定脑内血肿的最简便适用方法。
The incidence, mortality, and disability rate of spontaneous intracerebral hemorrhage (SICH) are high, and its surgical and medical treatment is still controversial. With the development of micro-neurosurgical technology, minimally invasive surgery (MIS) has made great progress in the treatment of SICH. It can remove intracerebral hematoma in the early stage after SICH and minimize or eliminate secondary brain injury, which is of great significance to reducing the mortality and disability rate. For many years, due to its continuous progress, MIS has been more and more widely used in the treatment of SICH. This article mainly reviews the progress of MIS in SICH and related clinical research at home and abroad, and briefly describes several innovative techniques related to MIS, which aims to promote the exchange of clinical experience in MIS of SICH.
Objective To assess the clinical efficacy of endovascular treatment in the second stage for patients with progression to local or full-length dissection-like changes at the distal aorta following initial surgery for aortic intramural hematoma. Methods Between July 2020 and December 2022, patients with aortic intramural hematoma were treated initially for proximal lesions. During follow-up, if the distal aortic hematoma was not resorbed and entry tears were identified with progression to local or full-length dissection-like changes and possible focal contrast enhancement, and the patients undergoing a second-stage stent intervention were retrospectively collected. Initial surgeries included total aortic arch replacement or thoracic endovascular aortic repair (TEVAR) targeting the proximal entry tear. In the secondary stage, stents were strategically placed in three delineated regions of the distal aorta to seal the entry tears, promote hematoma resorption, and induce thrombosis of the false lumen. Results A total of 18 patients were collected, including 15 males and 3 females with a mean age of 53.5±10.6 years, ranging from 39 to 76 years. All patients achieved procedural success, yielding a technical success rate of 100%. Intraoperative and postoperative imaging confirmed effective sealing of the distal entry tears without stent leakage, visceral branch stenosis, or occlusion, and there were no serious complications such as perioperative cerebral infarction, paraplegia, or organ ischemia. Follow-up assessments showed complete thrombosis and disappearance of the false lumen in all patients. Conclusion In patients with unresolved entry tears and dissection-like changes post-initial surgery for aortic intramural hematoma, secondary stent placement effectively seals these tears, promotes thrombosis and resorption of the hematoma, and improves endovascular remodeling of the aorta, demonstrating favorable short- to medium-term outcomes.
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.