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目的分析复发性和机化型慢性硬脑膜下血肿(CSDH)的病理特征和手术治疗效果。方法回顾性分析4例复发性和4例机化型CSDH患者的临床资料。患者均行大骨瓣开颅血肿清除加血肿包膜切除术。结果观察血肿包膜超微结构显示,复发性和机化型CSDH包膜壁层均见丰富的新生毛细血管,管径扩张,局灶内皮细胞不连续,基底膜不完整,周围可见红细胞渗出。包膜脏层仅见少量的毛细血管,周围是大量纤维间质,未见红细胞渗出。术后复查头颅CT示血肿清除满意,术后随访1~3个月,均无复发。结论血肿包膜壁层新生的毛细血管及其反复再出血可能是CSDH形成的关键因素。大骨瓣开颅血肿清除加血肿包膜切除术是复发性和机化型CSDH的有效手术治疗方式。
Objective To analyze the pathological features and surgical treatment of recurrent and localized chronic subdural hematomas (CSDH). Methods The clinical data of 4 patients with recurrent CSDH and 4 patients with CSDH were retrospectively analyzed. Patients were treated with large craniotomy hematoma plus hematoma capsule resection. Results The ultrastructure of the hematoma capsule showed that both recurrent and mechanized CSDH capsule wall were rich in nascent capillaries with diameter expansion, discontinuous focal endothelial cells, incomplete basement membrane, peripheral erythrocyte effusion . Envelope dirty layer only see a small amount of capillaries, surrounded by a large number of fibrous interstitial, no erythrocyte effusion. Postoperative recurrent skull CT showed satisfactory hematoma, follow-up 1 to 3 months after surgery, no recurrence. Conclusions The capillaries and repeated rebleeding of hematoma capsule lining may be the key factors for the formation of CSDH. Large craniotomy hematoma removal plus hematoma en bloc resection is a recurrent and mechanized CSDH effective surgical treatment.