脑疝复位天幕切开与常规手术治疗重型脑外伤脑疝疗效探讨  

Treatment of Severe Craniocerebral Herniation with Craniocerebral Incision and Conventional Surgical Operation

作　　者：邱志锋 姚长青 

机构地区：[1]菏泽市第二人民医院神经外科,山东菏泽274000

出　　处：《系统医学》2017年第13期70-72,共3页Systems Medicine

摘　　要：目的探讨脑疝复位天幕切开与常规手术治疗重型脑外伤脑疝的临床疗效观察。方法选取该院2014年1月—2016年1月收治的重型脑外伤脑疝患者50例,根据手术方法的不同,将患者分为天幕切开组与常规手术组,比较两组患者的临床疗效与并发症发生情况。结果天幕切开术组30例,死亡9例(30.00%),重度残疾/长期昏迷12例(40.00%),中度残疾/恢复良好9例(30.00%)。常规手术组20例,死亡12例(60.00%),重度残疾/长期昏迷6例(30.00%),中度残疾/恢复良好2例(10.00%)。两组患者的临床疗效比较,差异有统计学意义(P<0.05)。天幕切开术组30例,发生大脑后动脉梗死7例(23.33%),发生应激性溃疡13例(43.33%),发生脑积水9例(30.00%)。常规手术组20例,发生大脑后动脉梗死9例(45.00%),发生应激性溃疡17例(85.00%),发生脑积水12例(60.00%)。两组患者发生应激性溃疡、脑积水的患者比较,差异有统计学意义(P<0.05)。结论天幕切开相比常规手术治疗重型脑外伤脑疝具有更好的临床疗效,死亡率相对较低,同时患者的残疾程度也优于常规手术组,并发症发生情况也优于常规手术组,值得在临床推广应用。Objective This paper tries to investigate the clinical efficacy of severe craniocerebral herniation with c ran -iocerebral incision and conventional surgical operation. Methods 50 severe traumatic bra in hernia patients in this hos-pital from January 2014 to January 2016 were selected and divided into the tentorium group and the conventional surgery group according to the different surgical methods, the clinical efficacy and the incidence of complications of the two groups were compared. Results Among the 30 cases of tentorium incision surgery group, 9 cases died （30.00%）, 12 cases of severe disability / long-term coma （40.00%）, 9 cases of moderate disabil i ty / good recovery （30.00%）. Among the 20 cases of conventional surgery group, 12 cases died （60.00%）, 6 cases of severe disabil i ty / long-term coma （30.00%）, 2 cases of moderate disability / recovery good （10.00%）. The difference was statist ical ly significant in the clinical efficacy in the two groups （P〈0.05）. Among the incision group, 7 cases of posterior cerebral artery infarction （23.33%）, 13 cases of stress ulcer （43.33%）, 9 cases of hydrocephalus （30.00%）; in the routine surgery group, 9 cases of posterior cerebral artery infarction （45.00%）, 17 cases of stress ulcer （85.00%）, 12cases of hydrocephalus （60.00%）. The difference was statistically significant in the two groups of stress ulcer and hydrocephalus（P〈0.05）. Conclusion The clinical curative effect of tentorium incision compared with conventional surgical treatment of severe traumatic brain injury with cerebral hernia is much better, with relatively lower mortality rate, and the occurrence of complications and the degree of disability are better than those of the conventional surgery group, therefore it is worth clinical application.

关 键 词：天幕裂孔切开 脑疝 重型脑外伤 

分 类 号：R651[医药卫生—外科学]