超高齢者の慢性硬膜下血腫に対する五苓散料の効果

Effectiveness of Kampo Medicine Gorei-san-ryo for Chronic Subdural Hematoma in Very Elderly Patients

Ⅰ．はじめに

　慢性硬膜下血腫（chronic subdural hematoma, CSDH）は外科的疾患である．しかしながら，一度の手術侵襲によって完治しないものは10～20％存在し^6,9,13)，高齢者ではその割合も高い⁶⁾．CTやMRIの普及により無症状な例や軽微な症状しか示さない例を発見する機会は増えており，日常の臨床で手術適応に迷うことがある．特に高齢者では入院自体が侵襲と考えられ，手術自体は成功したものの寝たきりになったなどという話も聞く．一方でCSDHの自然消退例も報告されており¹⁰⁾，CSDHの非外科的治療法が種々示されてきた^4,15)．高齢者の場合は，報告されている非外科的治療ですらその副作用や利便性から躊躇する場合も多い．今回われわれは，80歳以上の高齢者（超高齢者）のCSDHに対する漢方薬である五苓散料の効果を検討し，有用であったので報告する．

Chronic subdural hematoma (CSDH) is mainly a disease of the elderly. Widespread use of CT and MRI has resulted in the discovery of CSDH cases with no or minimum symptoms in the elderly. Treatment is by surgical evacuation,although small hematoma may resolve spontaneously. Treatment of CSDH in elderly patients of more than 80 years of age with minimum symptoms is still undetermined. Many conservative treatments such as those with steroids and diuretics have been reported with some good results. Conservative treatment cannot become the procedure of choice for fear of side effects.

　We report successful treatment for CSDH cases among the very elderly with a Kampo medicine (Japanese traditional herbal medicine). Among a total eleven cases,four were recurrent after surgical evacuation and seven showed significant hematoma with minimal symptoms. Gorei-san-ryo,a Kampo medicine,was administered for 3 to 12 months. Some cases showed rapid hematoma resolution after administration. Only one of them required subsequent surgical intervention.

　This conservative treatment with Kampo medicine for CSDH may be a potential alternative to surgery especially for the elderly.