不同手术入路治疗双额叶挫裂伤的效果及对颅内压的影响  

Effect of different surgical approaches on bilateral frontal lobe contusion and laceration and its influence on intracranial pressure

作　　者：冯世云[1] 谢宗义[2] 苟少中 蔡聪隆 耿家发 李文权 Feng Shiyun;Xie Zongyi;Gou Shaozhong;Cai Conglong;Geng Jiafa;Li Wenquan(Department of Neurosurgery,the People's Hospital of Ningnan County,Ningnan,Sichuan 615400;Department of Neurosurgery,the Second Affiliated Hospital of ChongqingMedical University,Chongqing,400010,China)

机构地区：[1]宁南县人民医院神经外科,四川宁南615400 [2]重庆医科大学第二临床学院神经外科

出　　处：《西南国防医药》2019年第2期104-106,共3页Medical Journal of National Defending Forces in Southwest China

摘　　要：目的探讨单侧或双侧手术入路治疗双额叶挫裂伤的临床效果及对术后颅内压的影响。方法回顾性分析85例双额叶挫裂伤患者的临床资料,根据手术入路方式不同分为双侧组与单侧组,比较两组围手术期相关指标、并发症发生情况、格拉斯哥(GCS)评分及术后颅内压变化。结果单侧组的手术时间、术中出血量和住院时间均显著少于双侧组(P <0.05),嗅神经损伤、精神障碍、贫血和低蛋白血症的发生率显著低于双侧组(P <0.05);两组术后次日颅内压均在正常范围内,术后3～5 d达到峰值,之后下降,组间比较无统计学差异(P> 0.05);随访6个月后,双侧组的预后良好率为73.81%,单侧组为81.40%,两组比较无统计学差异(P> 0.05)。结论单侧手术入路治疗双额叶挫裂伤对患者的损伤小,术中出血量少,恢复快,并发症发生率低,患者预后较好,对于符合单侧手术入路适应证的患者推荐使用。Objective To explore the clinical effect of unilateral or bilateral surgical approach for bilateral frontal lobe contusion and laceration and its influence on the intracranial pressure after the operation. Methods The clinical data of 85 patients with bilateral frontal lobe contusion and laceration were retrospectively analyzed. They were divided into a bilateral group and an unilateral group according to different surgical approaches. The perioperative indexes, complications, Glasgow Scale (GOC) score and intracranial pressure changes were compared between the two groups. Results The operation time, intraoperative bleeding volume and hospitalization time of the unilateral group were significantly less than those of the bilateral group (P < 0.05), and the incidence of olfactory nerve injury, mental disorder, anemia and hypoproteinemia was significantly lower than that of the bilateral group (P < 0.05);the intracranial pressure of the two groups was within the normal range the next day after the operation, peaked 3-5 days after the operation and then decreased, and there was no statistical difference between the two groups (P > 0.05). After six months of follow-up, the good prognosis rate was 73.81% in the bilateral group and 81.40% in the unilateral group. There was no significant difference between the two groups (P > 0.05). Conclusion For bilateral frontal lobe contusion and laceration, unilateral surgical approach has less injury, less bleeding, faster recovery, lower incidence of complications and better prognosis. It is recommended for patients who meet the indications of unilateral surgical approach.

关 键 词：单侧 双侧 手术入路 双额叶 挫裂伤 临床效果 

分 类 号：R561.15[医药卫生—呼吸系统]