慢性硬膜下血腫における術後残存空気と再発の関係

Relationship of Postoperative Residual Air and Recurrence in Chronic Subdural Hematoma

I．はじめに

　慢性硬膜下血腫は外科的に根治可能であるが，しばしば再発が問題になり，再発率は1.7〜38％である^4,7,11）．開頭血腫除去術と穿頭血腫洗浄術による再発率に差がないとされることから^3,8），高齢者に頻発する本疾患においては，局所麻酔下で行える穿頭血腫洗浄術が低侵襲^2）である．再発要因は多様であるが，とりわけ，術後の残存空気が注目されている^1）．今回，残存空気の速やかな排気の目的で慢性硬膜下血腫洗浄後にドレナージ挿入経路を内視鏡を用いて決定し，ドレナージ先端を血腫の最前頭側に留置することを試み，2,3の知見を得たので報告する．

The possibility exists that residual air after surgery is one cause of recurrence of chronic subdural hema- toma. We have devised a new simple method which decreases postoperative residual air, using external drainage and an endoscope. First, we make endoscopic observations of the inner aspect of the hematoma cavity. Then, we insert external drainage apparatus into the most frontal area of the hematoma cavity, we regard this location as the most appropriate place to ensure most effective drainage.

The present study included 37 chronic subdural hematomas in 32 patients who had been treated between January and December, 1999. Their ages ranged from 48 to 86 years old, with an average of 72 years. In-sertion of external drainage in the most frontal area of the hematoma cavity was successfully achieved in27 (73%, Group I) out of 37 cases and resulted in no recurrence. In the remaining 10 hematomas (27%,Group II), external drainage was not able to be inserted in the most frontal area, and fourhematomas(40%) had recurrence (p＜0.01 vs Group I).

Insertion in the most frantal area of the hematoma cavity decreases residual air after surgery, and mayhe effective for the prevention of recurrence of chronic subdural hematoma.