颞肌下颅骨修补术后迟发性血肿的诊治探讨  

Exploration of the diagnosis and treatment for delayed intracranial hematoma after cranioplasty under the temporalis

作　　者：张文清[1] 黄绳跃[1] 郑诗豪[1] 陈忠仪[1] 洪文瑶[1] 廖正俭[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,福州350001

出　　处：《中国微侵袭神经外科杂志》2017年第3期112-114,共3页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：福建省科学技术厅社会发展引导性(重点)项目(编号:2016Y0017)

摘　　要：目的探讨数字成型钛网颞肌下颅骨修补术后并发迟发性血肿的发病机制及处理方法。方法回顾性分析15例采用数字成型钛网进行颞肌下颅骨修补术后并发迟发性血肿病人的临床资料和处理方法。结果血肿量>35 ml 11例,其中神志不清3例,采用急诊血肿清除术治愈;神志清醒但术后3 d内发现血肿3例,采用尿激酶灌注引流治愈;病人一般情况良好但3 d后血肿逐渐增大5例,采用血肿穿刺引流术治愈。血肿量20~30 ml 4例,未出现意识、瞳孔及病人肢体活动变化,采用保守治疗后痊愈。术后随访3个月,15例病人未复发。结论对颞肌下颅骨修补术后迟发性血肿,应密切观察神志、瞳孔及肢体活动,动态复查颅脑CT,并及时采取不同方法处理,预后良好。Objective To discuss the pathogenesis and therapeutic method for delayed intracranial hematoma after cranioplasty under the temporalis with digital forming titanium mesh. Methods Clinical data and treatment method of 15 patients with delayed intracranial hematoma undergoing cranioplasty under the temporalis with digital forming titanium mesh were analyzed retrospectively. Results The volume of hematoma was more than 35 ml in 11 patients, of whom, 3 with obnubilation were cured by craniotomy for hematoma aspiration. Three conscious patients were found to have hematoma within 3 days after operation and were cured by urokinase perfusion and drainage. The hematomas gradually enlarged 3 days after operation in 5 patients with good general condition, and were cured by puncture and drainage. The other 4 patients with hematoma volume ranging from 20 ml to 30 ml were found no change of mind, pupil and activity, and were cured by conservative treatment. All the patients were followed up for 3 months after operation and none recurred. Conclusions We should closely observe the change of mind, pupil and limb activity, repeat the brain CT scan and select various therapeutic methods in time for the patients with intracranial hematoma after cranioplasty under the temporalis, and can achieve a good prognosis.

关 键 词：血肿 硬膜外 颅骨缺损 颅骨修补术 颞肌下 数字成型钛网 

分 类 号：R651.15[医药卫生—外科学]