硬膜下积液术后顽固性蛛网膜下腔出血5例成因分析  

The Causes Analysis of 5 Cases with Intractable Subarachnoid Hemorrhage after Subdural Effusion Operation

作　　者：何程[1] 林爱国[1] 刘小波[1] 唐宏图[1] 周鸿伟[1] 蒋君[1] 

机构地区：[1]遂宁市第一人民医院,四川遂宁629000

出　　处：《中外医学研究》2014年第17期130-131,共2页CHINESE AND FOREIGN MEDICAL RESEARCH

摘　　要：目的：为解决硬膜下积液术后顽固性蛛网膜下腔出血致难治性头痛，特探讨术后蛛网膜下腔出血成因及治疗方式。方法：对笔者所在医院2010-2012年发生的5例硬膜下积液术后并发顽固性蛛网膜下腔出血患者的临床资料进行回顾性分析。结果：5例发生顽固性蛛网膜下腔出血患者均为快速进展型硬膜下积液（间隔3~4 d复查头颅CT发现积液明显增多）。积液位于额颞顶部，经钻孔引流处理，术中发现蝶骨脊均有1~2处蛛网膜破损，给予蛛网膜破口处扩大造瘘处理。术后复查头颅CT积液残腔持续存在。术后均出现顽固性蛛网膜下腔出血。经腰椎穿刺、腰池引流等处理后蛛网膜下腔出血消退极度缓慢。4例患者1＋个月后顽固性蛛网膜下腔出血自行缓解，1例并发颅内感染，死亡。复查头颅MR发现均有较前增厚包膜形成。结论：顽固性蛛网膜下腔出血形成可能与快速进展型硬膜下积液相关，可能与术中积液腔沟通蛛网膜下腔相关，可能与术后积液残腔持续存在相关。缓解可能与积液腔封闭相关。为避免硬膜积液术后顽固性蛛网膜下腔出血发生，建议快速进展型硬膜下积液手术注意保持积液腔与蛛网膜下腔封闭。Objective：To solve intractable headache induced by intractable subarachnoid hemorrhage after subdural effusion operation,to explore the causes and treatment of subarachnoid hemorrhage.Method：The clinical data of 5 cases with intractable subarachnoid hemorrhage after subdural effusion operation from 2010 to 2012 in author’s hospital were retrospectively analyzed.Result：5 cases of intractable subarachnoid hemorrhage patients were rapidly progressive subdural effusion （interval of 3-4 days after head CT revealed effusion increased）.Effusion in frontotemporal and parietal,after trephination and drainage treatment, intraoperative findings sphenoid ridge has 1-2 arachnoid damage,giving the arachnoid break in the expansion of fistula treatment.Postoperative cranial CT effusion cavity persists.Postoperative intractable subarachnoid hemorrhage.After lumbar puncture,lumbar cistern drainage treatment of subarachnoid hemorrhage after extremely slow fading.4 cases of patients with intractable subarachnoid hemorrhage relieved after 1＋ months,1 case complicated with intracranial infection,death. Review of cranial MR findings was thickened capsule formation.Conclusion：With the rapid advances in the types and formation may epidural effusion under relevant conclusions refractory subarachnoid hemorrhage,may be associated with intraoperative fluid cavity communication subarachnoid,may be associated with postoperative residual cavity persistent effusion.Relief may be associated with effusion cavity.In order to avoid the subdural effusion after the formation of refractory subarachnoid hemorrhage,suggest rapid progressive subdural effusion in operation to keep the effusion cavity and subarachnoid closed.

关 键 词：硬膜下积液术后 顽固性蛛网膜下腔出血 积液腔与蛛网膜下腔封闭 

分 类 号：R743.35[医药卫生—神经病学与精神病学]