无脑疝外伤性脑内血肿的锥颅软通道引流治疗  

Cranial puncture and soft channel catheter drainage for traumatic brain hematoma without cerebral hernia

作　　者：姚国杰[1] 陈亮[1] 李成才[2] 韦可[1] 陈大瑜[1] 杜威[1] 肖炳祥[1] 龚杰[1] 徐国政[1] 

机构地区：[1]广州军区武汉总医院神经外科 中国人民解放军神经外科研究所,430070 [2]十堰太和医院神经外科

出　　处：《临床外科杂志》2015年第11期841-843,共3页Journal of Clinical Surgery

摘　　要：目的：分析简易头皮定位下锥颅软通道置管引流治疗外伤性脑内血肿的效果。方法对34例（格拉斯哥评分6~14分）未发生脑疝的外伤性脑内血肿患者行头皮简易定位下锥颅软通道置管引流治疗，术后给予尿激酶盐水溶解血肿。结果33例疗效满意，患者均在8 d 内清除血肿量的80％~90％。引流时间3~5天19例，6~8天14例，平均住院时间24天。1例患者因术后血肿扩大、意识障碍加深行开颅去骨瓣减压。33例患者随访6~24个月。按日常生活能力（ADL）评定患者远期疗效，Ⅰ级：25例，Ⅱ级：3例，Ⅲ级：3例，Ⅳ级：1例，Ⅴ级：1例；复查头颅 CT发生轻度脑积水仅1例（2.9％）。结论对于未发生脑疝、病情相对稳定的颅脑损伤患者，锥颅治疗外伤性脑内血肿简单易行、创伤小、恢复快，并发症少。Objective To investigate the effects of cranial puncture and soft channel catheter drainage on traumatic brain hematoma without cerebral hernia. Methods Thirty-four patients（GCS 6 ~14）with traumatic brain hematoma were treated with cranial puncture and soft channel catheter drainage after scalp marker-guided location. Urokinase was used for irrigation and drainage. Results Satisfactory effects were achieved in 33 cases. The volume of hematoma（80% ~ 90% ）was removed within 8 days af-ter operation. The drainage catheter was placed for 3 ~ 5 days in 19 cases and 6 ~ 8 days in 14 cases. The average hospital stay was 24 days. After the operation,disturbances of consciousness was aggravated by hematoma in one patient and the patient received additional decompressive craniotomy. Long-term effects were evaluated by the activities of daily living（ADL）and the rest 33 patients were divided into 5 levels, including 25 cases of levelⅠ,3 cases of level Ⅱ,3 cases of level Ⅲ,one case of level Ⅳ and one case of level Ⅴ. During the follow-up period（6 ~ 24 months）,cerebral CT only found mild hydrocephalus in one patient. Conclusion For traumatic brain hematoma,cranial puncture has advances in simplicity, minimal invasion,quick recovery and limited complications,which is suitable for stable patients without cerebral hernia.

关 键 词：脑内血肿 锥颅引流术 微创手术 开颅手术 去骨瓣减压术 

分 类 号：R651.1[医药卫生—外科学]