急性硬脑膜下血肿减压术后对侧进展性硬脑膜外血肿的早期诊治  

Early diagnosis and treatment for contralateral progressive epidural hematomas after decompressive craniectomy of acute traumatic subdural hematoma

作　　者：徐立[1,2] 唐超[1] 陈磊[1] 曹铖[1] 丁圣豪[1] 高国一[1] 包映晖[1] 潘耀华[1] 梁玉敏[1] 江基尧[1] 

机构地区：[1]上海交通大学医学院附属仁济医院神经外科,200127 [2]江苏省张家港市中医院神经外科

出　　处：《临床神经外科杂志》2012年第6期321-323,共3页Journal of Clinical Neurosurgery

基　　金：上海市卫生局资助项目(2009059);卫生部卫生公益性行业科研专项研究(200802093)

摘　　要：目的探讨颅脑外伤去骨瓣减压术(DC)后对侧进展性硬脑膜外血肿(EDH)的临床特点和早期诊治方法。方法对23例颅脑外伤术后对侧进展性EDH患者的资料进行回顾性分析。结果术后对侧进展性EDH的平均确诊时间为(4±3)h;EDH的部位为颞顶部12例,枕顶部9例,额颞部2例;主要表现为术中脑肿胀8例,术后对侧瞳孔散大4例,术后ICP逐渐增高4例,神经系统无明显异常改变者7例。保守治疗1例,再手术22例,21例确认血肿处骨折存在。出院时GOS评分5分5例,4分7例,3分7例,2分者1例,1分3例。结论急性外伤性硬脑膜下血肿(SDH)术后对侧进展性EDH以颞顶和枕顶部最多见,冲击部位颅骨骨折处出血是最主要的机制,早期确诊和治疗有助于改善预后。Objective To investigate the clinical features and the methods for early diagnosis and treatment of contralateral progressive epidural hematoma （EDH） after decompressive craniectomy （DC） of acute traumatic subdural hematoma（SDH）. Methods The clinical data of 23 patients with contralateral EDH after DC of acute traumatic SDH were analyzed retrospectively. Its clinical manifestations, results of CT scanning and outcome were summarized. Results The average interval time of confirmed diagnosis for contralateral progressive EDH after DC was （4 ＋ 3）hours. The EDH was located in parietotemporal regions in 12 cases, parieto-occipital regions in 9 and fronto-temperal regions in 2. The main manifestations included intra-operative brain swelling in 8 cases, contralateral pupil dilation post-DC in 4, increasing of ICP value in 4 and no neurological change in 7. Conservative therapy was made for 1 patient, and second operation was made in 22 for the evacuation of EDH with that skull fracture was found in 21 below EDH. According to Glasgow Outcome Scale （GOS）, scores of 5,4,3,2 and 1 were experienced in 5,7,7,1 and 3 patients respectively on discharge. Conclusions Majority of contralateral progressive EDH after DC of acute traumatic SDH are occurred in parietotemperal and perieto-occipital regions. And delayed bleeding from skull fracture at the site of the EDH is its main mechanism of such EDH. Early diagnosis and prompt management is contributed to the improvement of such cases.

关 键 词：颅脑外伤 急性硬脑膜下血肿 进展性硬脑膜外血肿 预后 

分 类 号：R651.1[医药卫生—外科学]