鞍区颅脑枪击伤的救治  

Treatment for craniocerebral gunshot wounds in sellar region

作　　者：陈长才[1] 汪求精[1] 李铁林[1] 杨俊[1] 徐如祥[1] 

机构地区：[1]第一军医大学附属珠江医院神经外科,广州510282

出　　处：《中华创伤杂志》2002年第5期267-269,共3页Chinese Journal of Trauma

摘　　要：目的　探讨鞍区颅脑枪击伤急性期的救治及晚期鞍区金属异物摘除的方法。　方法　对 7例鞍区颅脑枪击伤患者行早期清创术 ,3例患者同时摘除金属异物 ;4例患者晚期采用显微手术摘除下丘脑、垂体内金属弹丸。所有患者均获随访 ,随访时间 3～ 11年。　结果　全部患者均康复 ,无下丘脑或垂体功能障碍。恢复良好 3例 ,轻残 3例 ,重残 1例。　结论　鞍区颅脑枪击伤患者 ,应早期行清创术 ,尽可能摘除金属异物 ,修补颅底脑膜防止脑脊液漏。术后加强抗感染、抗脑水肿治疗。重症患者需及时治疗继发性脑损害 ,积极治疗内分泌紊乱等并发症 ,在全身情况稳定后 ,采用显微手术摘除异物。Objective To explore the treating method for craniocerebral gunshot wounds in the sellar region during the acute period and the extirpating method for the metallic foreign bodies from the sellar region during the late stage. Methods Early debridement was made on 7 patients, simultaneously, the metallic foreign bodies were taken out from 3 patients. The metallic foreign bodies in the hypothalamus and the hypophysis were taken out from 4 patients with microsurgical technique at the late stage. All the patients were followed up for 3-11 years. Results All the patients had no hypothalamic or pituitary dysfunction. Three patients recovered well, 3 were disabled mildly and 1 disabled severely. Conclusions Debridement should be made early on the patients with craniocerebral gunshot wounds in the sellar region and the metallic foreign bodies should be removed as far as possible. If the patient is serious, foreign bodies may be removed in the later stage. The basicranial meninges must be repaired to prevent leakage of the cerebrospinal fluid. Anti-infection and prevention of brain edema should be strengthened after operation. Secondary brain injury and endocrine disorder should be treated timely for the patients with severe injury. After the patient's condition is stable, the foreign bodies can be removed with microsurgical operation. Microsurgical technique is a safe and reliable method for removing metallic foreign bodies in the deep functional position of the brain.

关 键 词：鞍区颅脑 枪击伤 救治 颅脑损伤 创伤 显微外科手术 

分 类 号：R826.5[医药卫生—临床医学]