超高齢者慢性硬膜下血腫の臨床的特徴と治療成績

Clinical Features and Surgical Results of Chronic Subdural Hematoma in the Extremely Aged Patients

Ⅰ．は じ め に

　慢性硬膜下血腫は低侵襲の手術により劇的な症状の改善が得られるため，高齢者に対しても積極的に手術が推奨される疾患といえる．近年では80歳以上のいわゆる超高齢者においても手術を行う機会があるが，この際は全身の予備機能や状態を考慮し外科的治療の適応や方法を十分検討する必要がある．しかしながら超高齢者慢性硬膜下血腫に関する報告は少なく⁹⁾，若年者と比較した手術成績も明らかではない．また，高齢者の慢性硬膜下血腫では若年者とは異なる臨床的特徴が指摘されているが^3,4,12,17)，超高齢者例で検討した報告も少ない．そこで今回，80歳以上の手術症例の患者背景や臨床症状，治療および転帰についてretrospectiveに分析し，80歳未満の例と比較検討したので報告する．

Since low-invasive surgery provides marked symptomatic improvement of patients with chronic subdural hematoma,surgery will be recommended also for the aged. To examine the clinical features and treatment result in the aged patients,we compared the clinical features and surgical results in two groups of patients with 80 or more and less than 80 years. The subjects consisted of 266 adult patients with a total of 333 chronic subdural hematomas who had undergone closed-system drainage between January 1995 and March 2005. The items analyzed were 1) patients background including gender,laterality of hematoma,presence or absence of history of head trauma,history of drinking,and mechanism of injury,2) clinical symptoms,such as level of consciousness on initial examination,initial symptoms,and the degree of paralysis,3) those related to surgery,such as time from injury to surgery,length of hospital stay,operation time,and amount of drainage,4) outcome,such as presence or absence of symptomatic improvement,and recurrence rate. The results of this study showed that chronic subdural hematomas in the extremely aged patients were characterized by 1) infrequent history of head trauma,2) infrequent headache and frequent dementia,incontinence and deterioration of activity at onset,3) severe degree of motor paralysis at admission,4) larger amount of drainage volume,5) low incidence of outcome improvement.

　Above these characteristics should be considered at the decision making of surgical treatments for extremely aged patients with chronic subdural hematoma.