当院における慢性硬膜下血腫再発例の検討

Recurrent Cases of Chronic Subdural Hematoma : Its Clinical Review and Serial CT Findings

　88例，114個の成人慢性硬膜下血腫手術に対して再発例の臨床像およびCT所見の特徴を比較検討した。再発例が13例（14.8％），13個（11.4％）に認められた。その臨床像は高年齢者（平均年齢70.4歳），全員男。血腫は両側性で左右別では左，症状発現から手術までの期間は1週間までの例に多く，手術は全例血腫腔内洗浄のみで行った例であった。再発例術前のCT所見は術前の血腫吸収値がhighで，血腫腔はむしろ小に多く，手術早期例と考えられた。術後のCT所見は再発例では2週間後より血腫吸収値，正中偏位，血腫腔の消退に変化を認め，1〜2カ月後に悪化する例が多かった。硬膜下空気貯留は術後1週間までの残留が再発例に多かった。再発予防には，手術時期を十分に考慮して，血腫腔内洗浄法のみでなくドレーンも併用，空気残留量を少なくし，術後3カ月まではCTなどによる経過観察が必要と考えられた。

Eighty-eight cases (114 hematomas) of chronic subdural hematoma (SDH) were treated surgically using irrigation with or without drainage. 13 cases (14.8%), 13 hematomas (11.4%) showed recurrence after the 1st operation. They were compared with non-recurrent cases using clinical reviews and serial CT findings.

The result of the study showed that all of the patients in whom recurrence occurred were male and elderly (mean age 70.4 years). Many of these recurrences occurred in cases of bilateral SDH, on the left hematoma side, and at intervals within 7 days from the onset of clinical symptoms after the 1st operation. All recurrent cases were treated surgically using irrigation without drainage. In preoperative CT findings, it was shown that high density areas and small-sized hematomas were detected at a slightly higher rate in recurrent cases than in non recurrent cases. In postoperative CT findings, it was shown that many of the recurrent patients deteriorated during an interval from 2 weeks to 2 months. It was shown that non-recurrent patients had become almost normal by 3 months after the operation. Residual air volume into the subdural space within 7 days in recurrent cases was greater than in non-recurrent cases.

Therefore, using irrigation with drainage, plan-ning the operative timing, and reduction of residual air volume into subdural space are proposed as suitable means to avoid recurrence of SDH. Patients of SDH need postoperative follow-up dur-ing an interval up to 3 months.