创伤性硬膜下积液向慢性硬膜下血肿演变的 研究进展

Research Progress in the Evolution of Traumatic Subdural Effusion into Chronic Subdural Hematoma

摘要: 创伤性硬膜下积液(traumatic subdural effusion, TSE)是颅脑损伤后常见并发症之一，多数病例可自行吸收或保持稳定，但部分患者可进一步演变为慢性硬膜下血肿(chronic subdural hematoma, CSDH)。近年来研究表明，TSE向CSDH的转化并非单纯机械性脑脊液潴留所致，而是机械损伤、持续炎症反应、包膜形成与异常血管新生、局部凝血–纤溶失衡及反复微出血等多种因素共同参与的连续病理过程。临床研究提示，高龄、积液持续存在、双侧分布、厚度增加、密度升高、范围扩大及硬膜下间隙增宽等，可能是提示TSE向CSDH转化风险增高的重要因素；部分压力性因素亦可能在病变进展中起促进作用，但尚缺乏高质量证据。本文就TSE向CSDH演变的临床转归、主要发病机制及相关高危因素研究进展作一综述，以期为高危患者识别、动态影像随访及早期干预提供参考。

Abstract: Traumatic subdural effusion (TSE) is one of the common complications after craniocerebral injury. Most cases can be absorbed or remain stable by themselves, but some patients can further evolve into chronic subdural hematoma (CSDH). Recent studies have shown that the conversion of TSE to CSDH is not simply caused by mechanical cerebrospinal fluid retention, but a continuous pathological process involving mechanical injury, continuous inflammatory response, capsule formation and abnormal angiogenesis, local coagulation-fibrinolysis imbalance and repeated microbleeds. Clinical studies suggest that advanced age, persistent effusion, bilateral distribution, increased thickness, increased density, expanded range, and widened subdural space may be important factors that suggest an increased risk of conversion from TSE to CSDH. Some stress factors may also play a role in promoting the progression of the disease, but there is still a lack of high-quality evidence. This article reviews the clinical outcomes, main pathogenesis and related risk factors of the evolution from TSE to CSDH, in order to provide reference for the identification of high-risk patients, dynamic imaging follow-up and early intervention.