58例横窦骑跨性硬膜外血肿的微创手术治疗  

Minimally-invasive surgical treatment of 58 patients with epidural hematoma straddling transverse sinus

作　　者：陆兆丰[1] 邱永明[2] 程小兵[1] 孟晓峰[1] 

机构地区：[1]河南科技大学第一附属医院神经外科,洛阳471001 [2]上海交通大学医学院附属仁济医院神经外科,上海200001

出　　处：《上海交通大学学报（医学版）》2012年第8期1075-1078,共4页Journal of Shanghai Jiao tong University:Medical Science

摘　　要：目的探讨微创血肿引流术对横窦骑跨性硬膜外血肿的治疗效果。方法 58例创伤性横窦骑跨性硬膜外血肿患者术前格拉斯哥昏迷评分(GCS)8～12分,均在CT定位下以YL-1微创引流针穿刺血肿腔,并以尿激酶50 000～60 000 IU冲洗引流。术后1 h、3 d及7 d行CT动态扫描,计算血肿量;术后3个月行格拉斯哥预后评分(GOS)。结果 CT显示术后1 h血肿量平均为(20±5)mL,术后3 d为(15±2)mL,均较术前的(45±15)mL显著减少(均P<0.05)。术后3～5 d血肿均完全清除。术后5 d平均GCS为(12±1)分,较术前的(8±4)分显著提高(P<0.05)。术后3个月GOS 5分(恢复良好)者45例(占78%),4分(中度残疾)者9例(占16%)。结论微创血肿引流术对GCS≥8分的创伤性横窦骑跨性硬膜外血肿疗效确切,创伤小且操作简便。Objective To investigate the therapeutic effect of minimally-invasive drainage on epidural hematoma straddling transverse sinus. Methods Fifty-eight patients with traumatic epidural llematoma straddling transverse sinus and preoperative Glasgow Coma Score （GCS） 8 to 12 points were managed with minimally-invasive drainage under CT location, and 50 000 to 60 000 IU of urokinase was used for irrigation and drainage. CT scanning was performed 1 h, 3 d and 7 d after operation, volumes of hematoma were calculated, and Glasgow Outcome Score （GOS） was evaluated 3 months after operation. Results The volumes of hematoma 1 h and 3 d after operation were （20±5） mL and （ 15±2） mL respectively, and were significantly lower than that before operation [ （45±15） mL] （P 〈0. 05）. The hematoma was totally removed 3 to 5 d after operation. GCS was （ 12±1） points 5 d after operation, which was significantly higher than that before operation [ （8±4） points] （P 〈 0. 05）. Three months after operation, good recovery （GOS 5 points） was achieved in 45 patients （78%）, and moderate disability （ GOS 4 points） was found in 9 patients （ 16% ）. Conclusion Minimally-invasive drainage is effective in the treatment of traumatic eoidural hematoma straddling transverse sinus with GCS≥8 ooints.

关 键 词：横窦骑跨性硬膜外血肿 微创引流 格拉斯哥昏迷评分 

分 类 号：R651.15[医药卫生—外科学]