额颞枕M型超大骨瓣联合内减压术在颅脑损伤后接受二次减压患者中的应用  

Large M-shaped eraniotomy combined with lobectomy for secondary decompression in patients following severe craniocerebral trauma： a single center retrospective study

作　　者：黄巍[1] 王文浩[1] 林洪[1] 罗飞[1] 林俊明[1] 李君[1] 张源[1] 胡连水[1] 郑建仙 Huang Wei;Wang Wenhao;Lin Hong;Luo Fei;Lin Junming;Li Jun;Zhang Yuan;Hu Lianshui;Zheng Jianxian(Department of Neurosurgery, 175th Hospital of PLA, Southeast Hospital Affiliated to Xiamen University, Center of Traumatic Neurosurgery, Naujing Military Commcond, Zhangzhou 363000, China)

机构地区：[1]解放军第一七五医院暨厦门大学附属东南医院神经外科、南京军区创伤神经外科中心,漳州363000

出　　处：《中华神经医学杂志》2018年第6期575-581,共7页Chinese Journal of Neuromedicine

基　　金：福建省自然科学基金（2018J01152）;南京军区医药卫生科研基金（MS095）

摘　　要：目的探讨改良额颞枕M型超大骨瓣联合内减压术（简称M型超大骨瓣联合内减压术1治疗颅脑损伤后接受二次减压患者的疗效。方法回顾性分析解放军第一七五医院暨厦门大学附属东南医院神经外科自2007年1月至2010年1月收治的76例颅脑损伤后接受二次减压患者的临床资料，其中术前颅内压30-40mmHg（1mmHg=0．133kPa）40例，颅内压〉40mmHg36例。患者首次开颅时均采用标准大骨瓣减压术．二次减压时行额颞叶内减压术或M型超大骨瓣联合内减压术。比较不同术式组患者的存活率和颅内压的变化，出院后6个月根据格拉斯哥预后评分（GOS）判断患者的疗效。结果颅内压30-40mmHg患者中22例采用M型超大骨瓣联合内减压术，18例采用额颞叶内减压术。术后7d内M型超大骨瓣联合内减压术治疗组患者存活率（72．7％）高于额颞叶内减压术治疗组（38．9％），差异有统计学意义（P〈0．05）。颅内压〉40mmHg患者中19例采用M型超大骨瓣联合内减压术，17例采用额颚叶内减压术．术后7d内均死亡。二次减压术后存活患者中行额颞叶内减压术7例，行M型超大骨瓣联合内减压术16例，M型超大骨瓣联合内减压术治疗组患者术后1d、术后3周时颅内压明显低于额颞叶内减压术治疗组，差异有统计学意义（P〈0．05）；与额颞叶内减压术治疗组比较，M型超大骨瓣联合内减压术治疗组患者出院后6个月GOS评分较高，预后较好，差异有统计学意义（P〈0．05）；2种术式组患者外伤性癫痫、硬膜下积液、脑组织软化、切口愈合不良的发生率差异无统计学意义（P〉0．05）。结论对于标准去骨瓣减压术后仍存在严重脑肿胀及梗死、颅内压小于40mmHg的颅脑损伤患者，采用M型超大骨瓣联合内减压可较单纯额颞叶内减压更为显著降低患者颅内压水平，提高生存率，改善预后。Objective To explore the clinical efficacy of large M-shaped craniotomy combined with lobectomy for secondary decompression in patients following severe craniocerebral trauma. Methods The clinical data were retrospectively analyzed of the 76 patients who had undergone secondary decompression following severe craniocerebral trauma from January 2007 to January 2010. The preoperative intracranial pressure （ICP） was 30-40 mmHg in 40 cases and 〉40 mmHg in 36 ones. All the patients received regular lobectomy in primary craniotomy; for secondary decompression some received simple lobectomy and some large M-shaped craniotomy combined with lobectomy. The patients undergoing different surgical procedures were compared in terms of survival rate, changes in intracranial pressure and therapeutic efficacy by the GOS 6 months post-discharge. Results Of the patients with 30,-40 mmHg ICP, 22 underwent large M-shaped craniotomy combined with lobectomy and 18 simple lobectomy. The survival rate within 7 days after surgery for the former patients （72.7%） was significantly higher than that for the latter ones （38.9%） （P〈0.05）. Of the patients with 〉40 mmHg ICP, 19 underwent large M-shaped craniotomy combined with lobectomy and 17 simple lobectomy, but all of them died within 7 days after surgery. Of those surviving the secondary decompression, 7 received simple lobectomy and 16 large M-shaped craniotomy combined with iobectomy, The ICP in the latter patients was significantly lower at postoperative one day and 3 weeks than that in the former ones （P〈0.05）. Compared with those receiving simple lobectomy, the patients receiving combined procedures had significantly higher GOS and significantly better prognosis （P〈0.05）. There were no significant differences between the patients receiving two different surgical procedures in such adverse events as traumatic epilepsy, cerebrospinal fluid leakage, softening brain tissue, or wound malunion （P〉0.05）. Conclusion For the patients with craniocerebral tra

关 键 词：颅脑损伤 额颞枕M型超大骨瓣联合内减压术 额颞叶内减压术 

分 类 号：R651.15[医药卫生—外科学]