颅脑损伤标准大骨瓣减压术后并发硬膜下积液(附28例分析)  

Subdural effusion after standard decompressive craniectomy in patients with traumatic brain injury(report of 12 cases)

作　　者：李兵[1] 胡世颉[1] 高大宽[1] 胡学安[1] 王冰[1] 刘伟[1] 曹宝萍[1] 费舟[1] 

机构地区：[1]第四军医大学西京医院神经外科,西安710032

出　　处：《中国临床神经外科杂志》2014年第2期80-82,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨颅脑损伤标准大骨瓣减压术后并发硬膜下积液的原因和防治方法。方法回顾性分析28例颅脑损伤标准大骨瓣减压术后并发硬膜下积液患者的临床资料，其中18例采用单纯骨窗加压包扎，3例行局部穿刺后骨窗加压，2例行置管持续引流术，5例保守治疗（3例有效，另2例保守治疗后行积液腔-腹腔分流术）。结果治疗后28例积液均消失。出院后随访8～24个月，无复发病例。治疗后6个月GOS评分：恢复良好14例，中残7例，重残5例，植物生存2例。结论硬膜下积液是颅脑损伤标准大骨瓣减压术后常见并发症，影响患者功能恢复，早预防、早发现和早治疗可取得满意的效果。Objective To explore the pathogenesis, prevention and treatment of subdural effusion after standard decompressive cranieetomy in the patients with traumatic brain injury （TBI）. Methods The clinical data of the 28 patients with subdural effusion after the standard decompressive eraniectomy for TBI were analyzed retrospectively, including the clinical manifestations, imaging data and so on. Of 28 patients with subdural effusion, 3 were conservatively treated and 25 surgically. The literatures related to the subdural effusion were reviewed. The therapeutic measures included compressive bandaging of the bone windows in 18 cases, local puncture and compressive bandaging of the bone windows in 3, lasting the drainage in 2, effusion cavity-peritoneal shunt in 2 and conservative treatment in 3. Results The subdural effusion disappeared after the treatment in these 28 patients, of whom, 2 had subdural effusion ipsilaleral to the cranieetomy （3 cases of paralogngitudinal cerebral fissures） and 7 eontralateral. Of 28 patients with subdural effusion, 14 recovered well, 7 were slight disabled, 5 were severely disabled, and 2 survived vegetatively. Conclusions The subdural effusion, which is the common complication after the standard decompressive cranieetomy in the patients with TBI, had bad effects on the recovery of the patients. Early prevention, early diagnosis and early treatment are the key to the satisfactory prognosis.

关 键 词：颅脑损伤 标准大骨瓣减压术 硬膜下积液 治疗 

分 类 号：R651.15[医药卫生—外科学] R651.11[医药卫生—临床医学]