急性重度颅脑外伤伴天幕裂孔疝的手术治疗  

Surgical Treatment of Acute Severe Craniocerebral Trauma with Tentorial Herniation

作　　者：向进 郭伟 王莉莉 陈东 赵永阳 

机构地区：[1]暨南大学第二临床医学院深圳市人民医院,深圳518020

出　　处：《中国现代手术学杂志》2010年第3期209-212,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的比较标准外伤大骨瓣开颅血肿清除去大骨瓣减压并天幕裂孔疝复位术与常规大骨瓣开颅血肿清除去大骨瓣减压术对急性重度颅脑损伤伴天幕裂孔疝的治疗效果。方法 40例急性重度颅脑伤伴天幕裂孔疝患者(GCS≤8分)随机分为两组,每组20例。研究组采用标准外伤大骨瓣开颅血肿清除去大骨瓣减压并脑疝腹位术,对照组采用常规大骨瓣开颅血肿清除大骨瓣减压术。术后1 d、3 d、7 d对两组GCS评分、颅内压、脑水肿范围和中线结构移位等指标进行比较。结果术后3 d、7 d研究组较对照组的GCS评分、颅内压、脑水肿范围和中线结构移位等指标有显著改善(P<0.01)。术后1年随访,研究组和对照组生存率分别为85%和60%,重残及死亡率分别为25%和50%,组间比较有显著差异(P<0.05或P<0.01)。结论标准外伤大骨瓣开颅血肿清除去大骨瓣减压并天幕裂孔疝复位术能提高患者生存率,减少死残率,是手术治疗重度颅脑外伤伴天幕裂孔疝的有效方法。Objective To compare the therapeutic effect between the standard large trauma craniotomy with atrium hernia reposition and conventional large craniotomy in treatment of acute severe craniocerebral trauma with tentorial herniation.Methods 40 cases of acute severe craniocerebral trauma with tentorial herniation（GCS ≤8 score） were randomized into study group and control group,with 20 cases for each.The study group was performed standard large trauma craniotomy,hematoma removal,decompression of large craniectomy and tentorial herniation reposition,and the control group was performed conventional large craniotomy,hematoma removal,decompression of large decompressive craniectomy.The GCS score,intracranial pressure（ICP）,brain edema volume and midline shift range were compared at the time points of 1-,3-and 7 days after operation between two groups.Results The GCS score,ICP,cerebral edema volume and midline shift range of study group was improved significantly than those of control group at the time points of 3 and 7 days after operation（P〈0.01）.The one-year follow-up review showed the survival rate was 85% and 60%,and the rate of severe disability and death was 25% and 50% in study group and control group respectively,and there was obviously difference between two groups（P0.05 or P0.01）.Conclusion The surgical measures of standard large trauma craniotomy,hematoma removal,decompression of large craniectomy and tentorial herniation reposition can increase survival rate and decrease the severe disability and death rate,and it is an effective method for severe craniocerebral trauma with tentorial herniation.

关 键 词：颅脑损伤 开颅术 天幕裂孔疝 减压术 外科 

分 类 号：R651.1[医药卫生—外科学]