神经内镜辅助大骨瓣减压腰池引流治疗颅脑损伤并颞叶钩回疝的疗效研究  

The efficacy of neuroendoscope-assisted drainage with lumbar cistern and large bone flap decompression in the treatment of craniocerebral trauma complicated with temporal uncinate herniation

作　　者：张效珏 魏秀川 刘杰 Zhang Xiaojue;Wei Xiuchuan;Liu Jie(Department of Craniocerebral Disease Surgery,Lanling County People′s Hospital,Linyi 277799,China)

机构地区：[1]兰陵县人民医院颅脑疾病外科,临沂277799

出　　处：《中国医师进修杂志》2023年第6期566-570,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨神经内镜辅助大骨瓣减压腰池引流治疗颅脑损伤并颞叶钩回疝的疗效。方法回顾性选择2017年1月至2020年10月于兰陵县人民医院住院治疗的80例颅脑损伤并颞叶钩回疝患者为研究对象,按手术方式不同分为观察组和对照组,每组40例。两组均由同一组经验丰富的神经外科医生完成手术操作,观察组采用神经内镜辅助大骨瓣减压腰池引流治疗,对照组仅采用大骨瓣减压术。术前及术后48 h复查头颅CT,比较两组术后环池、鞍上池显现率;比较两组术后3、5、7 d颅内压(ICP)值和格拉斯哥昏迷量表(GCS)评分;比较两组引流时间及并发症发生情况;术后6个月,采用格拉斯哥预后量表(GPS)评估两组预后情况。结果观察组环池、鞍上池术后显现率高于对照组[67.50%(27/40)比45.00%(18/40)、65.00%(26/40)比42.50%(17/40)],差异有统计学意义(χ^(2)=4.11、4.07,P<0.05)。观察组术后3、5、7 d ICP值低于对照组,GCS评分高于对照组,差异有统计学意义(P<0.05)。两组引流时间比较差异无统计学意义(P>0.05)。观察组术后脑水肿发生率低于对照组[7.50%(3/40)比25.00%(10/40)],差异有统计学意义(χ^(2)=4.50,P<0.05)。观察组术后脑梗死发生率低于对照组[5.00%(2/40)比22.50%(9/40)],梗死体积小于对照组[(6.68±1.75)cm^(3)比(8.20±2.15)cm^(3)],差异均有统计学意义(P<0.05);观察组术后并发症发生率低于对照组[17.50%(7/40)比40.00%(16/40)],差异有统计学意义(χ^(2)=4.94,P<0.05);术后6个月,观察组预后良好率高于对照组[62.50%(25/40)比35.00%(14/40)],差异有统计学意义(χ^(2)=6.05,P<0.05)。结论神经内镜辅助大骨瓣减压腰池引流治疗颅脑损伤并颞叶钩回疝具有较好的疗效和安全性。Objective To observe the effect of neuroendoscope-assisted drainage with lumbar cistern and large bone flap decompression in the treatment of craniocerebral injury complicated with temporal uncinate herniation.Methods A total of 80 patients with craniocerebral trauma and temporal uncinate herniation hospitalized in Lanling County People′s Hospital from January 2017 to October 2020 were retrospectively included and divided into the observation group and the control group according to the surgical methods,with 40 patients in each group.Surgical procedures were performed by the same group of experienced neurosurgeons.The observation group was treated with neuroendoscope-assisted drainage with lumbar cistern and large bone flap decompression,while the control group was treated with large bone flap decompression only.Cephalic CT was reexamined before and 48 h after the surgery to compare the appearance rates of cisterna ambiens and suprasellar cistern.Intracranial pressure(ICP)was monitored at 3,5 and 7 d after the surgery,and the scores of Glasgow coma scale(GCS)was recorded.Drainage time,postoperative cerebral edema and cerebral infarction complications were recorded and compared between the two groups.Six months after the surgery,the prognosis was assessed by the Glasgow prognostic scale(GPS).Results The occurrence rates of cisterna ambiens and suprasellarcistern in the observation group were higher than those in the control group:67.50%(27/40)vs.45.00%(18/40),65.00%(26/40)vs.42.50%(17/40),χ^(2)=4.11,4.07,P<0.05.The ICP value in the observation group at 3,5 and 7 d after the surgery were significantly lower than those in the control group,and the scores of GCS in the observation group were significantly higher than those in the control group,there were statistical differences(P<0.05).There was no statistically significant difference in drainage time between the two groups(P>0.05).The incidence of postoperative cerebral edema in the observation group was lower than that in the control group:7.50%(3/40)vs.25.00%(1

关 键 词：颅脑损伤 神经内窥镜 大骨瓣减压 腰池引流 颞叶钩回疝 

分 类 号：R651.15[医药卫生—外科学]