出血傾向を伴う慢性硬膜下血腫—11手術例の検討

Chronic Subdural Hematoma with Bleeding Tendency:Clinical analysis of 11 surgical cases

I．はじめに

　通常の慢性硬膜下血腫（以下CSDH）は穿頭術により良好な予後が得られる疾患である，しかしながら，出血傾向を伴うCSDHは比較的稀であり，しかも最近の止血機序の研究発展や治療法の進歩にもかかわらず，その予後は必ずしも良好とはいえない．また，保存的に治療される場合もあり，まとまった手術例の報告は散見されるにすぎない^8,9,22）．

　今回，著者らは出血傾向を伴うCSDHの11手術例を経験し，その多彩な臨床像と治療上の問題点について検討したので報告する．

Eleven patients with chronic subdural hematoma (CSDH) with bleeding tendency (BT) were surgically treated in the last 12 years.

To study the clinical problem of CSDH with BT, 11 surgical cases were divided into 3 groups, Group A; CSDH with primary BT (1 case of hemophilia A), Group B ; CSDH with BT secondary to a basic disease (3 cases of leukemia, 2 cases of malignant tumor with DIC, 1 case of chronic renal failure and 1 case of liver cirrhosis), Group C; CSDH with BT by anticoagulants (warfarin) (2 cases of replacement of mitral valve, 1 case of A-C bypass). Evacuation of the hematoma was performed by means of one or two burr holes with irrigation of the hematoma cavity and a drainage tube was placed in the subdural space.

The outcome was excellent in Groups A and C. In Group B, two patients with DIC clue to gastric cancer and prostatic cancer died, and 3 patients with leukemia recovered dramatically from CSDH, but the poor course of the disease itself resulted in death. The out-come of other patients in Group B was excellent. Since CSDH with BT is often fatal, those patients had usually been treated conservatively. However, from this analysis, we stress that CSDH with BT should be surgically treated after checking the blood conditions carefully to determine whether or not the patient has need for surgery.