不同术式治疗外伤性急性脑肿胀的临床效果对比研究  

Comparative study of effects on different operative methods in the treatment of traumatic acute brain swelling

作　　者：戴清波 郑文明 陈鸿尤 

机构地区：[1]三亚市人民医院神经外科,海南三亚572000

出　　处：《中国医学前沿杂志（电子版）》2017年第5期51-54,共4页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：海南省卫生厅资助项目(2014YW10)

摘　　要：目的比较双侧额颞平衡改良大骨瓣减压术与双侧标准大骨瓣开颅术治疗外伤性急性脑肿胀的临床效果。方法选取2012年1月至2016年10月于本院行手术治疗的外伤性急性脑肿胀患者103例为研究对象,将其随机分为两组,观察组52例患者接受双侧额颞平衡改良大骨瓣减压术,对照组51例患者接受双侧标准大骨瓣开颅术。比较两组患者的手术时间、术中出血量、术中脑膨出率、骨窗面积、术后并发症发生情况、术后基底池评分及术后格拉斯哥预后评分(Glasgow outcome scale,GOS)。结果观察组患者手术时间显著短于对照组(P<0.05),术中出血量显著少于对照组(P<0.05),骨窗面积显著大于对照组(P<0.05);观察组患者脑膨出率虽低于对照组,但无显著差异(P>0.05)。两组患者术后基底池评分和各级别GOS评分比较均无显著差异(P>0.05)。两组患者均出现并发症,观察组患者主要为硬膜下积液、感染,总并发症发生率为15.38%;对照组患者主要为脑膨出、硬膜下积液、脑积水、感染及颅骨缺损综合征,总并发症发生率为33.33%;观察组患者并发症总发生率显著低于对照组(P<0.05)。结论与双侧标准大骨瓣开颅术相比,双侧额颞平衡改良大骨瓣减压术手术时间更短,创伤更小,术后并发症发生率较低,对外伤性急性脑肿胀的治疗效果更佳。Objective To compare the effect of bilateral frontal-temporal symmetrically modified decompressive craniectomy and the bilateral standard big bone craniectomy in the treatment of traumatic acute brain swelling. Method 103 cases of traumatic acute brain swelling patients treated in our hospital from January 2012 to October 2016 were seleted as research objects, they were randomly divided into two groups, observation group patients （n = 52） were treated with bilateral frontal-temporal symmetrically modified decompressive craniectomy, control group patients （n = 51） were treated with bilateral standard big bone craniectomy. Operation time, intraoperative blood loss, the rate of encephalocele, bone window area, postoperative complications, postoperative basal cistern scores and postoperative Glasgow outcome scale （GOS） scores were compared between the two groups. Result Operation time in observation group was significantly shorter than that in control group （P 〈 0.05）, blood loss in observation group was significantly less than that in control group （P 〈 0.05）, and bone window area in observation group was significantly larger than that in control group （P 〈 0.05）. The rate of encephalocele in observation group was lower than that in control group, but there was no significant difference （P 〉 0.05）. There were no significant differences in postoperative basal cistern scores and different levels of GOS scores between the two groups （P 〉 0.05）. Both groups had complications, subdural effusion and infection were mainly complications of observation group, and the total incidence of complication was 15.38%, encephalocele, subdural effusion, hydrocephalus, infection and skull defect syndrome were mainly complications of control group, and the total incidence of complication was 33.33%. The total incidence of complications in observation group was significantly lower than that in control group （P 〈 0.05）. Conclusion Compared with bilateral standard big bone craniectomy, the bi

关 键 词：急性脑肿胀 双侧额颞平衡改良大骨瓣减压术 双侧标准大骨瓣开颅术 

分 类 号：R651.15[医药卫生—外科学]