控制减压技术在单侧开颅手术治疗对冲性颅脑损伤中的作用  

The role of controlled decompression in unilateral craniotomy for contrecoup traumatic brain injury

作　　者：疏龙飞 赵伟 代飞虎 杨理坤 王悦 程明 刘壮华 艾璞 王玉海 Shu Longfei;Zhao Wei;Dai Feihu;Yang Likun;Wang Yue;Cheng Ming;Liu Zhuanghua;Ai Pu;Wang Yuhai(Hospital of Chinese PLA Joint Services,Wuxi 214044,China)

机构地区：[1]中国人民解放军联勤保障部队第九〇四医院,无锡214044

出　　处：《中华神经外科杂志》2021年第5期490-494,共5页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(81871589);江苏省卫健委医学科研重点课题(K2019018);无锡市卫健委重大课题(Z201705)。

摘　　要：目的探讨控制减压技术在单侧开颅手术治疗对冲性颅脑损伤中的作用。方法2016年1月至2018年12月中国人民解放军联勤保障部队第九〇四医院神经外科采用单侧开颅手术治疗160例对冲性颅脑损伤患者,其中80例采用控制减压技术(控制减压组),80例采用常规减压技术(常规减压组)。两组患者的性别、年龄、损伤原因、术前瞳孔大小、格拉斯哥昏迷评分(GCS)、头部着力部位及受伤距手术时间的差异均无统计学意义(均P>0.05)。回顾性分析两组患者的手术时间,术中脑膨出的发生率,术后迟发性脑出血、远隔部位再次手术、脑梗死、癫痫、脑积水的发生率,以及术后6个月格拉斯哥预后评级(GOS)的差异。结果两组患者的手术时间以及术后迟发性脑出血、癫痫、脑积水的发生率差异均无统计学意义(均P>0.05);与常规手术组比较,控制减压组术中脑膨出[分别为13%(10/80)、33%(26/80)]、远隔部位再手术[分别为16%(13/80)、30%(24/80)]及术后脑梗死[分别为24%(19/80)、41%(33/80)]的发生率均低,差异均有统计学意义(均P<0.05)。术后6个月,控制减压组的预后良好率为35%(28/80),病死率为10%(8/80),均优于常规减压组的20%(16/80)和24%(19/80)(均P<0.05)。结论单侧开颅手术治疗对冲性颅脑损伤术中采用控制减压技术,能降低患者术中和术后部分并发症的发生率,并改善患者的预后。Objective To explore the role of controlled decompression in unilateral craniotomy for contrecoup traumatic brain injury.Methods The clinical data of 160 patients with contrecoup traumatic brain injury who underwent unilateral craniotomy at Department of Neurosurgery,the 904th Hospital of Chinese PLA Joint Services from January 2016 to December 2018 were retrospectively analyzed.Among them,80 patients underwent the surgery of controlled decompression(controlled decompression group),and the other 80 cases were treated with conventional decompression(conventional surgery group).There were no statistically significant differences in gender,age,cause of injury,preoperative pupil size,Glasgow Coma Score(GCS),the stress position,the time from injury to operation between the two groups of patients(all P>0.05).For the two groups of patients,we retrospectively analyzed their operation time,the incidence of intraoperative encephalocele,the postoperative incidences of delayed cerebral hemorrhage,reoperation of distant parts,cerebral infarction,epilepsy and hydrocephalus,and their difference in the Glasgow Outcome Score(GOS)at 6-month follow-up.Results There was no significant difference in the operation time,or postoperative incidences of delayed hemorrhage,epilepsy and hydrocephalus between the two groups(all P>0.05).However,compared with conventional surgery group,the controlled decompression group had lower incidences of intraoperative encephalocele[13%(10/80)vs.33%(26/80)],reoperation on remote site[16%(13/80)vs.30%(24/80)]and cerebral infarction[24%(9/80)vs.41%(33/80)](all P<0.05).At 6-month follow-up,the controlled decompression group had higher proportion of favored outcomes[35%(28/80)vs.20%(16/80)]and lower mortality[10%(8/80)vs.24%(19/80)]compared with the conventional surgery group(both P<0.05).Conclusion For the treatment of contrecoup traumatic brain injury,unilateral craniotomy with the assistance of controlled decompression technology could reduce the incidences of some intraoperative and postoperative complic

关 键 词：颅脑损伤 减压颅骨切除术 控制减压 对冲伤 单侧开颅术 

分 类 号：R651.15[医药卫生—外科学]