儿童远距离霰弹枪伤的颅脑外科处理  

Neurosurgical treatment of children＇s head shotgun injury at long distance

作　　者：王明[1] 蒋浩然 蒋宇钢[1] Wang Ming;Jiang Haoran;Jiang Yugang(Neurosurgery Department, the Second Xiangya Hospital of Central South University, Changsha 411000, China)

机构地区：[1]中南大学湘雅二医院神经外科,411000

出　　处：《神经疾病与精神卫生》2018年第1期47-51,共5页Journal of Neuroscience and Mental Health

摘　　要：目的探讨儿童远距离颅脑霰弹枪伤的临床特点及其颅脑外科救治。方法回顾性分析我科2000年1月～2017年1月连续收治的12例因颅脑霰弹枪伤入院患儿的临床资料，研究儿童霰弹枪伤与成年人一般火器伤的不同点，总结儿童远距离头颅霰弹枪伤的颅脑外科救治方法。结果12例颅脑霰弹枪伤的儿童行局部清创术3例，开颅术7例，立体定向术2例，再次开颅金属异物取出1例。术后金属异物残留6例，术后感染2例，术后癫痫1例，遗留永久性神经功能障碍1例。结论儿童远距离颅脑霰弹枪伤较一般成年人火器伤预后较好，术后远期疗效可观，对于此类型的枪伤，提倡进行相对保守的清创术，避免加重神经功能损伤。残留的金属异物并无明显增高术后感染和癫痫的概率。Objective To explore the clinical features of children＇s head shotgun injury at long distance by pellet and its neurosurgical treatment.Methods The clinical data of 12 children with skull shotgun wounds by pellet at distance,who were consecutively admitted in our hospital from January 2000 to January 2017 were retrospectively analyzed.The differences between children＇s head shotgun injury and general firearm injury in adults were studied.The neurosurgical treatment of children＇s head shotgun injury at long distance by pellet was summarized.Results There were three cases of local debridement,seven cases of craniotomy,two cases of stereotactic surgery and one case of re-craniotomy for the metal foreign bodies.There were six cases of metal foreign body residues after operation,two cases of postoperative infection,one case of postoperative epilepsy and one case of permanent neurological dysfunction.Conclusions Children＇s head shotgun injury at distance seems to have a better outcome compared to adults gunshot wounds,with considerable postoperative long-term effects.A relatively conservative debridement is suggested for this kind of gunshot injury,so as to avoid aggravating neurological damage.There is no significant increase in the incidence of postoperative infection and epilepsy with the presence of residual metal in the cerebral.

关 键 词：霰弹枪伤 儿童 清创术 感染 癫痫 

分 类 号：R826.68[医药卫生—临床医学]