减张减压术中合理硬膜修补面积的临床报告  

Clinical Report of a Reasonable Reduction of Epidural Decompression Repair Area

作　　者：刘明辉 侯保辉 季泰令[2] 

机构地区：[1]山东省德州市市立医院神经外科,德州253012 [2]山东省潍坊医学院附属医院神经外科,潍坊261031

出　　处：《中国医药导刊》2014年第3期452-453,455,共3页Chinese Journal of Medicinal Guide

摘　　要：目的：评价人工硬脑膜减张修复硬膜去骨瓣减压术减张修复硬膜所需人工硬膜面积大小对降低脑静脉回流障碍及硬膜下积液的疗效影响,探讨减张修复硬膜所需人工硬膜合理面积。方法：回顾性分析德州市立医院神经外科手术治疗重型颅脑损伤去骨瓣减压患者的临床资料,分为A、B、C三组,减张减压术中人工硬膜修补面积为减压窗硬膜面积的40%-60％病例为A组；修补面积大于减压窗面积60％病例为B组；修补面积小于减压窗硬膜面积的40％病例为C组。比较三组病例术后出现脑静脉回流障碍及硬膜下积液、减压是否充分的差异具有统计学意义。结果：三组间术前GCS评分、平均年龄、性别差异无统计学意义。通过A组、B组,及A组、C组进行统计学比较,A组在术后并发症及减压不充分方面分别优于B、C两组。结论：在减张减压术中人工硬膜修补面积为减压窗硬膜面积的40%-60％大小情况下有效降低脑静脉回流障碍及硬膜下积液的发生率疗效显著,对于临床有较强的指导意义。Objective：To explore the affection of artificial dura mater area used in the decompressive hemicraniectomy on cerebral venous return disturbance and subdural fluid accumulation, and to determin the appropriate artificial dura mater area in tension-reduced pachymeninx repair. Methods：Severe brain injury patients with decompressive hemicraniectomy admitted to department of neurosurgery, Dezhou municipal hospital were retrospectively analyzed. The patients were divided 3 groups：group A：artificial dura mater area used in the decompressive hemicraniectomy was 40%-60%of the area of the window dural decompression;Group B：artificial dura mater area was more than 60%of the area of the window dural decompression;and group C：artificial dura mater area was less than 40%of the area of the window dural decompression. The difference of cerebral venous return disturbance and subdural fluid accumulation among three groups were analyzed.Results：There were no significant difference in GCS score、mean age and sex among three groups （P〉0.05）. There were significant differences in postoperative complication and incomplete decompression between group A vs group B or group A vs group C. Conclusions：It was the appropriate artificial dura mater area when artificial dura mater area used in the decompressive hemicraniectomy was 40%-60%of the area of the window dural decompression, which can reduce the incidence of cerebral venous return disturbance and subdural fluid accumulation.

关 键 词：减张减压术 人工硬膜 重型颅脑损伤 脑静脉回流障碍 硬膜下积液 

分 类 号：R651.15[医药卫生—外科学]