幕下开颅肿瘤手术并发远隔部位血肿的早期识别和防治  

Early identification,prevention and treatment of hematoma in remote site after infratentorial craniotomy for tumors

作　　者：袁敏[1] 王莹 刘浩宇 向言召 陈明宇 徐铭 徐健 钟平 YUAN Min;WANG Ying;LIU Hao-yu;XIANG Yan-zhao;CHEN Ming-yu;XU Ming;XU Jian;ZHONG Ping(Department of Neurosurgery,the First People's Hospital of Changde,Changde 415003,Hunan Province,China;Department of Neurosurgery,Huashan Hospital,Fudan University,Shanghai 200040,China;Department of Neurosurgery,Central Hospital of Shaoyang,Shaoyang 422000,Hunan Province,China;Department of Neurosurgery,the People's Hospital of Shimen County,Changde 415300,Hunan Province,China)

机构地区：[1]常德市第一人民医院神经外科,常德415003 [2]复旦大学附属华山医院神经外科,上海200040 [3]邵阳市中心医院神经外科,邵阳422000 [4]石门县人民医院神经外科,常德415300

出　　处：《复旦学报（医学版）》2023年第6期862-868,共7页Fudan University Journal of Medical Sciences

基　　金：中国医学科学院医学与健康科技创新工程项目(2019-I2M-5-008);上海申康医院发展中心临床三年行动计划(SHDC2020CR1049B)。

摘　　要：目的 总结幕下开颅肿瘤手术并发的远隔部位血肿病例,探讨早期识别方法和防治策略。方法 回顾性分析复旦大学附属华山医院神经外科颅底亚专科组自2019年12月至2021年11月收治的幕下开颅肿瘤手术患者的临床资料,总结远隔部位血肿发生部位、血肿类型,分析产生原因,探讨术中术后如何早期识别及防治策略。结果 490例幕下开颅肿瘤手术患者中,出现远隔部位血肿18例(3.67%),其中幕上硬膜下血肿9例,枕部硬膜外血肿3例,幕上硬膜下血肿合并纵裂血肿2例,脑室内血肿2例,纵裂血肿1例,颞叶脑内血肿合并蛛网膜下腔出血1例。2例患者术中准确识别,终止手术,术中CT复查明确出血类型后手术治疗;16例在术后早期识别,CT复查明确出血类型,1例采取手术治疗,15例采取保守治疗。所有18例病例术后随访2~21个月,无死亡病例。结论 幕下开颅肿瘤手术并发远隔部位血肿是一种少见且严重威胁手术安全的并发症,多表现为幕上硬膜下血肿、硬膜外血肿、脑室内血肿及脑内血肿等,可合并蛛网膜下腔出血;围手术期积极预防、早期准确识别和及时有效的处理能显著改善患者的预后。Objective To summarize the cases of hematoma in remote site after infratentorial craniotomy for tumors,and to explore the early identification methods as well as prevention and treatment strategies.Methods The clinical data of patients who underwent infratentorial craniotomy for tumors from Dec 2019 to Nov 2021 in the skull base subspecialty group of the department of neurosurgery,Huashan Hospital,Fudan University were retrospectively analyzed to summarize the location and type of hematoma in remote sites and its causes,and to explore its early identification methods and prevention strategies.Results Among the 490 patients who underwent infratentorial craniotomy for tumors,18 patients(3.67%)developed hematoma in remote site,including 9 cases with supratentorial subdural hematoma,3 cases with occipital epidural hematoma,2 cases with supratentorial subdural hematoma combined with interhemispheric subdural hematoma,2 cases with intraventricular hematoma,1 cases with interhemispheric subdural hematoma,and 1 patient temporal lobe intracerebral hematoma combined with subarachnoid hemorrhage.Two cases were accurately identified during operation,and the operation was terminated.Intraoperative head CT was performed to determine the type of hematoma,and surgical treatment was performed.All the other 16 cases were identified in the early postoperative period,and head CT was performed to identify the type of hematoma.One patient was treated with surgery and 15 cases were treated conservatively.All the 18 cases were followed up for 2-21 months after operation,and there was no death case.Conclusion The hematoma in remote site after infratentorial craniotomy for tumors is a rare and serious threat to the safety of surgery,mostly manifested as supratentorial subdural hematoma,epidural hematoma,intraventricular hematoma,interhemispheric subdural hematoma and intracerebral hematoma,which can be associated with subarachnoid hemorrhage.Perioperative active prevention,early and accurate identification as well as timely and effective

关 键 词：开颅手术 幕下肿瘤 远隔部位 颅内血肿 早期诊断 治疗 

分 类 号：R739.41[医药卫生—肿瘤]