颅骨成形术联合对侧硬膜下钻孔引流治疗单侧去骨瓣减压术后对侧顽固性硬膜下积液的临床效果研究  

Clinical study of cranioplasty combined with contralateral subdural drilling drainage for the treatment of contralateral intractable subdural effusion after unilateral decompressive craniectomy

作　　者：王小刚 朱伟杰[1] 崔娜 王伯栋 WANG Xiao�gang;ZHU Wei-jie;CUI Na(Department of Neurosurgery,The 960th Joint Service Support Hospital of thePeople's Liberation Army,Jinan 250031,China)

机构地区：[1]中国人民解放军联勤保障第960医院神经外科,250031 [2]中国人民解放军联勤保障第960医院超声诊断科,250031

出　　处：《中国实用医药》2023年第18期49-52,共4页China Practical Medicine

基　　金：国家自然科学基金资助项目(项目编号:81801191)。

摘　　要：目的评估颅骨成形术联合对侧硬膜下钻孔引流治疗单侧去骨瓣减压术(DC)后对侧顽固性硬膜下积液的安全性及有效性。方法21例单侧DC术后对侧顽固性硬膜下积液患者,经过局部加压、腰穿、腰大池引流、钻孔引流等多种途径综合治疗后效果不佳,对侧硬膜下积液顽固存在,且积液呈进行性增加表现,所有患者均及时接受了颅骨成形术联合硬膜下对侧钻孔引流,术后定期观察硬膜下积液以及脑室变化情况。结果21例患者术后定期复查头颅CT显示,积液在术后1周内即明显减少,1个月内逐渐减少至基本消失,长期随访硬膜下积液未见复发。21例患者均预后良好,神经功能障碍较术前均有不同程度改善;10例患者后期随访发现脑积水逐渐形成,脑室进行性扩张并出现神经功能症状,行脑室腹腔分流手术治疗后预后良好。结论颅骨成形术联合对侧硬膜下钻孔引流治疗单侧DC术后对侧顽固性硬膜下积液安全有效,能早期改善患者预后。Objective To evaluate the safety and effectiveness of cranioplasty combined with contralateral drilling drainage for the treatment of contralateral intractable subdural effusion after decompressive craniectomy(DC).Methods 21 patients with intractable subdural effusion after unilateral DC were included in the study.The results were unsatisfactory after comprehensive treatment through various approaches,including local compression,lumbar puncture,lumbar cistern drainage,and drilling drainage.The contralateral subdural effusion persisted and the effusion showed progressive increase.All patients in this group received timely cranioplasty combined with contralateral subdural drilling drainage,and the changes of subdural effusion and cerebral ventricles were regularly followed up after surgery.Results Cranial CT examination of 21 patients showed that the effusion was significantly reduced within 1 week after surgery,and gradually decreased to basically disappeared within 1 month;no recurrence of subdural effusion was observed in long-term follow-up.All the 21 patients had a good prognosis,and their neurological dysfunction was improved to different degrees.10 patients were found to have hydrocephalus,progressive ventricular dilatation,and neurological symptoms at the later follow-up stage,and the prognosis was good after ventriculoperitoneal shunt surgery.Conclusion Cranioplasty combined with contralateral drilling drainage for the treatment of contralateral intractable subdural effusion after unilateral DC is safe and effective,and can improve the prognosis of patients in early stage.

关 键 词：颅骨成形术 对侧硬膜下钻孔引流 去骨瓣减压术 对侧 顽固性硬膜下积液 

分 类 号：R651.15[医药卫生—外科学]