重型颅脑损伤致中央型脑疝的手术治疗
Surgical treatment of central herniation in severely-head injured patients
孙胜玉 1马辉 1郝少才 1夏鹤春 1牛占峰 1吴亮 1贾晓雄1
作者信息
- 1. 750004 银川,宁夏医科大学附属医院神经外科
- 折叠
摘要
目的 探讨重型颅脑损伤致中央型脑疝的临床诊治特点和手术救治时机及方法.方法 回顾性分析2010年7月—2012年12月收治的20例双额叶脑挫裂伤致中央型脑疝患者的临床资料,其中男11例,女9例;年龄18 ～ 70岁,平均42岁.致伤原因:交通伤15例,坠落伤3例,斗殴伤2例.入院立即手术8例,观察后急诊手术12例.所有手术均采用双侧额颞同时开颅平衡减压,其中6例为双侧去骨瓣减压,14例为单侧去骨瓣减压.采用格拉斯哥预后评分(GOS)对疗效进行评估,根据蒙特利尔认知评估量表评价患者认知功能.观察并发症发生情况.结果 患者均获随访6～12个月,平均8个月.按GOS标准:恢复良好10例,中残6例,重残2例;植物状态1例,死亡1例.蒙特利尔认知评估量表评价:术后11例伴有不同程度的人格改变和智能障碍为主的精神障碍,12个月后恢复正常.并发癫痫5例,脑积水2例. 结论 对于重度颅脑损伤致中央型脑疝患者,若出现意识、瞳孔恶化及CT复查见血肿增大、中线结构明显移位需急诊手术.及时行双侧额颞开颅平衡减压,可有效降低双额叶脑挫伤致中央型脑疝患者的病死率和病残率,提高生活质量.
Abstract
Objective To determine the characteristics of treatment and diagnosis,surgical timing and surgical methods in severely head-injured patients with central herniation.Methods Twenty patients with central herniation caused by contusions and lacerations of the bilateral frontal lobes hospitalized from July 2010 to December 2012 were retrospectively reviewed.There were 11 males and 9 females,at mean age of 42 years (range,18-70 years).Injury was caused by traffic accidents in 15 patients,falls in 3 and fighting events in 2.Eight patients were treated immediately on admission and twelve patients underwent emergency operation.All the operations involved simultaneous bilateral craniectomy for decompression,including bilateral decompressive craniectomy in 6 patients and unilateral decompressive craniectomy in 14 patients.Glasgow Outcome Scale (GOS) and Montreal Cognitive Assessment were used to evaluated outcome evaluation and cognitive impairment respectively.Complications were recorded.Results All patients were followed up for 6-12 months (mean,8 months).According to GOS,good recovery was presented in 10 patients,moderate disability occurred in 6,severe disability in 2,vegetative state in 1,and death in 1.Eleven patients suffered severe mental disorders especially personality change and disturbance of intelligence,and restored after 12 months.Five patients were complicated by epilepsy and two hydrocephalus.Conclusions For central herniation in patients with severe head injury,an emergent surgery is necessary if there exist conscious disturbance and pupil aggravations,hematoma enlargement and significant displacement of midline structure.Timely bilateral balance decompressive craniectomy is effective to reduce the mortality and disability and improve quality of life.
关键词
脑损伤/脑疝/减压术,外科Key words
Brain injuries/Encephalocele/Decompression, surgical引用本文复制引用
出版年
2016
NETL
NSTL
维普
万方数据