中文摘要：

目的探讨影响慢性硬膜下血肿（CSDH）钻孔引流术后复发的因素及多种危险因素对其复发的累积风险。方法回顾性分析西南医科大学附属医院神经外科自2010年1月至2015年12月收治的有完整资料的257例行钻孔引流术的CSDH患者，其中未复发234例（未复发组），复发23例（复发组）。比较2组患者年龄、高血压、糖尿病、血肿特点、术前血肿厚度、术前中线偏移程度、出院时血肿厚度、出院时中线偏移程度及血肿密度等影响复发的可能危险因素，采用Logistic回归确定影响复发的独立危险因素并计算多重因素的累积风险。结果2组患者年龄、高血压、糖尿病、术前血肿厚度、术前中线偏移程度、出院血肿厚度、出院时中线偏移程度及血肿密度差异有统计学意义（P〈0．05）。年龄、糖尿病、术前血肿厚度及出院时中线偏移程度为钻孔术后复发的独立危险因素。不同危险因素的累积效应表现为具有2种独立危险因素患者的复发风险为具有1种或无复发独立危险因素患者的4．222～9．500倍，具有3种或4种独立危险因素患者复发风险甚至高达38．000倍。结论CSDH钻孔引流术后复发的独立危险因素包括高龄、糖尿病、术前血肿厚度≥20mm及出院时中线偏移程度≥5mm，合并的独立危险因素越多其累计的复发风险越高。

英文摘要：

Objective To explore the risk factors of recurrence of chronic subdural hematoma （CSDH） after drilling and drainage, and to explore the cumulative risk of various risk factors in recurrence. Methods A retrospective analysis of 257 patients with CSDH, admitted to and accepted complete drainage in our hospital from January 2010 to December 2015, was performed; 234 patients were without recurrence and 23 patients with recurrence. The risk factors of relapse, including age, hypertension, diabetes, hematoma characteristics, preoperative hematoma thickness, preoperative median deviation, hematoma thickness at discharge, midline deviation at discharge and hematoma density, were analyzed. Logistic regression analysis was performed to conform the independent risk factors and cumulative risk of multiple possible risk factors. Results Univariate analysis showed that age, hypertension, diabetes mellitus, preoperative hematoma thickness, preoperative median deviation, hematoma thickness at discharge, midline deviation at discharge and hematoma density were significantly different between the patients without recurrence and patients with recurrence （/9〈0.05）. Age, diabetes mellitus, preoperative hematoma thickness, and midline shift at discharge were independent risk factors for postoperative drilling recurrence. The cumulative effect of risk factors was that patients with two independent risk factors had a relapse risk of one 4.22-9.50-fold in patients with or without recurrence-independent risk factors, with a risk of recurrence of up to 38.0-fold in patients with three or four independent risk factors. Conclusions The risk factors of recurrence of chronic subdural hematoma after bile duct drainage are age, diabetes mellitus, preoperative hematoma thickness ≥20 mm and midline deviation ≥ 5 mm at discharge. When more independent risk factors are combined, fold increase of cumulative risk of recurrence is noted.