额颞区大面积颅骨缺损数字成型钛网修补术后并发对侧颅内血肿的诊治探讨  

Investigation of diagnosis and treatment of postoperatively concurrent ipsilateral intracerebral hematoma after digital shaped cranioplasty with titanium mesh to large area of skull defect in frontal and temporal region

作　　者：张文清[1] 黄绳跃[1] 洪文瑶[1] 廖正俭[1] 陈忠仪[1] 

机构地区：[1]福建医科大学省立临床学院福建省立医院神经外科,福建福州350001

出　　处：《中国现代医生》2016年第26期4-8,F0003,共6页China Modern Doctor

基　　金：福建省科学技术厅社会发展引导性(重点)项目(2016Y0017)

摘　　要：目的 探讨额颞区大面积颅骨缺损数字成型钛网颞肌下颅骨修补术后并发对侧颅内血肿的发病机制及防治方法。方法 回顾性分析2010年1月-2014年1月6例颞肌下颅骨修补术后并发对侧急性颅内血肿患者的临床资料和手术方法。结果 6例均颅骨缺损面积大头皮塌陷严重,术程进行了剥离颞肌、悬吊硬膜、皮瓣下负压引流等操作,术后继发的对侧急性颅内血肿均采用急诊开颅颞顶枕硬膜外血肿清除术后治愈。结论 大面积颅骨缺损颞肌下颅骨修补术后并发对侧颅内血肿的诊治应从血肿形成机制分析,提高手术技巧及采取预防措施能够避免发生血肿;密切观察患者的神志瞳孔变化及肢体活动,动态复查颅脑CT,及时诊断并进行开颅血肿清除术效果良好。Objective To investigate of the pathogenesis and intervention of postoperatively concurrent ipsilateral intracerebral hematoma after digital shaped cranioplasty with titanium mesh to large area of skull defect in frontal and temporal region. Methods The clinical materials and operation approaches of 6 patients with subtemporal cranioplasty combined with ipsilateral intracerebral hematoma From Jan 2010 to Jan 2014 were retrospectively analyzed. Results The area of skull defect was large and the scalp was severely collapsed for the 6 cases. The operations like temporalis stripping, dural suspension and sub-flat negative pressure drainage were all performed. The subsequently occurred acute intracranial hematoma was cured by emergent parietal-occipital epidural hematoma removal through cranioplasty. Conclusion The treatment and diagnosis of subtemporal cranioplasty concurrently occurred ipsilateral intracerebral hematoma should be analyzed from the pathogenesis of hematoma, improve the operation technique and take timely preventive measures to avoid hematoma; the changes of spirit and pupils as well as the motion of limbs should be closely monitored. Dramatically re-examining the cerebral CT and timely diagnosing as well as removing the hematoma by craniotomy has good effect.

关 键 词：颅骨缺损 数字成型钛网 颞肌下颅骨修补术 对侧血肿 额颞区 

分 类 号：R651.1[医药卫生—外科学]