前额底脑挫裂伤的手术时机探讨  

A study on the surgery time for brain contusion at anterior cranial fossa area

作　　者：郭剑峰[1] 王占祥[1] 谭国伟[1] 方耀春[1] 姜月明[1] 朱宏伟[1] 薛伟明[1] 叶永造[1] 陈四方[1] 沈上杭[1] 

机构地区：[1]福建医科大学附属厦门第一医院神经外科,福建厦门361000

出　　处：《中华神经外科疾病研究杂志》2007年第1期59-62,共4页Chinese Journal of Neurosurgical Disease Research

基　　金：福建省厦门市科技局重大疾病研究基金资助项目(3502Z20052021)

摘　　要：目的探讨前额底脑挫裂伤的手术时机。方法回顾性分析我院自1998年7月至2005年5月收治的前额底脑挫裂伤并施行手术的病例。结果入院即行手术(含24h内)14例为A组;初期保守治疗,24h后手术24例为B组。入院时GCS:A组平均6.5分,B组平均13分。随访半年并根据GOS判定:A组康复良好8例(57.1%),中度残废3例(24.1%),重度残废2例(14.3%),死亡1例(7.1%);B组康复良好8例(33.3%),中度残废5例(20.8%),重度残废7例(29.2%),死亡4例(16.7%)。入院时A组GCS普遍低于B组,GOS结果A组良好率高于B组,A组重残率、死亡率低于B组,具有显著统计学差异(P<0.05)。结论前额底脑挫裂伤早期(24h以内)明确手术指征,筛选出可能恶化的病例并及时手术对改善前额叶底脑挫裂伤的预后具有积极意义。Objective To investigate the surgery time for brain contusion at anterior cranial fossa area. The retrospective study analysis was conducted in the patients with the brain contusion surgery at anterior cranial fossa area in our hospital from July 1998 to May 2005. Results A total of 14 cases subjected to the hospitalized surgery immediately were included into group A. In group B, 24 cases were given routine treatments initially, and then underwent surgery therapy after 24 h. The average score of Glasgow Coma Scale （GCS） of patients is 6.5 in group A, and 13 in group B. After 6 months＇follow-up study on those patients, it was found that in group A, 8 cases （51.7%） got recovery, 3 cases （24.1%） appeared to be moderately disabled, 2 cases （ 14.3% ） were severely disabled, and 1 case （7. 1% ） was dead. In group B, 8 cases （33.3%） got recovery, 5 cases （20.8%） tended to be moderately disabled, 7 cases （29.2%） were severely disabled, and 4 cases （ 16. 7% ） were dead. Patients in group A generally have the lower GCS than those in group B before any therapy in both groups. The proportion of patients with good GCS in group A was higher than that in group B. However, the proportion for severely disabled patients and mortahty rate in group A were significantly lower than those in group B, respectively （P 〈 0. 05）. Conclusion It＇s pivotal to ensure clear indications for surgery at anterior cranial fossa area in the early stage of cerebral contusion injury （within 24 h）, and select the progressively deterirated cases to carry on surgery as early as possible so as to improve the prognosis of patients for brain contusion.

关 键 词：脑挫裂伤 前额底 手术时机 手术指征 

分 类 号：R651.15[医药卫生—外科学]