颞叶钩回疝患者术中进行脑疝复位及小脑幕切开的临床效果  

Clinical study of cerebral hernia reset and tentorium cerebelli hiatus incision in the surgery of tentorial herniation

作　　者：张伟 周加华 刘永 王为文 段吉强 ZHANG Wei;ZHOU Jia-hua;LIU Yong;WANG Wei-wen;DUAN Ji-qiang(Neurosurgery Department, Tangdu Hospital of the Fourth Military Medical University, Xi＇an 710038;Neurosurgery Department,Weinan Central Hospital, Weinan 714000, China)

机构地区：[1]空军军医大学唐都医院神经外科,陕西西安710038 [2]渭南市中心医院神经外科,陕西渭南714000

出　　处：《临床医学研究与实践》2018年第12期61-62,共2页Clinical Research and Practice

摘　　要：目的回顾分析格拉斯哥昏迷评分(GCS)3~5分的颞叶钩回疝患者的手术治疗经验。方法选取我科2012年4月至2016年11月收治的46例GCS 3~5分的颞叶钩回疝患者,在标准外伤大骨瓣开颅术操作之外加行脑疝复位及小脑幕切开,对其预后进行回顾性分析。结果分别随访1年,其中死亡7例(15.2%)(包括院内死亡4例、出院后死于肺部并发症者3例),植物状态生存4例(8.7%),重残8例(17.4%),中残13例(28.3%),恢复良好14例(30.4%)。结论标准外伤大骨瓣开颅术结合脑疝复位及小脑幕切开能更加有效直接地缓解脑干的受压,降低颅内压,预防枕叶脑梗死的发生,降低患者的死亡率,一定程度改善患者的预后。Objective To retrospectively analyze the treatment experience of the surgery of tentorial herniation in patients with Glasgow coma scale（GCS） of 3-5 points. Methods Forty-six patients with tentorial herniation and GCS of 3-5 points admitted in our department from April 2012 to November 2016 were selected. They were given cerebral hernia reset and tentorium cerebelli hiatus incision on the basis of standard large trauma craniotomy, and the prognosis was retrospectively analyzed. Results At one year follow-up, there were seven cases（15.2%） died（included four cases died in hospital and three cases died of pulmonary complications after hospital discharge）. There were four cases in vegetative state（8.7%）, eight cases with severe disability（17.4%）, thireen cases with moderate disability（28.3%）, and fourteen patients with good recovery（30.4%）. Conclusion The technique of standard large trauma craniotomy combined with cerebral hernia reset and tentorium cerebelli hiatus incision can effctively and immediately relieve the pressure of the brain stem, reduce the intracranial pressure, prevent the occurrence of occipital cerebral infarction, reduce the mortality of patients, and improve the prognosis of patients to a certain extent.

关 键 词：颞叶钩回疝 脑疝复位 小脑幕切开 

分 类 号：R651[医药卫生—外科学]