锥颅软通道引流术治疗儿童急性创伤性颅内血肿  

Cranial puncture and drainage under CT guidance for acute traumatic intracranial hematomas in children

作　　者：韦可 杜威 陈大瑜 杨柳 姚国杰 WEI Ke;DU Wei;CHEN Da-yu;YANG Liu;YAO Guo-jie(Department of Neurosurgery,General Hospital of Central Theater Command,Wuhan 430070,China)

机构地区：[1]中部战区总医院神经外科,武汉430070

出　　处：《中国临床神经外科杂志》2023年第10期646-648,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨CT定位辅助锥颅软通道引流术治疗儿童急性创伤性颅内血肿的疗效。方法回顾性分析2016年5月至2021年10月收治的42例急性创伤性颅内血肿患儿的临床资料。结果硬膜外血肿26例,血肿量(25.5±5.53)ml;脑挫裂伤并脑内血肿12例(单发8例,多发4例),血肿量(20.25±2.2)ml;基底节区血肿4例,血肿量(20.75±2.38)ml。行CT定位锥颅穿刺软通道引流术,引流2~5 d,引流量20~60 ml。42例患儿均顺利出院,无颅内感染及迟发性出血等并发症,无癫痫发作。出院时,6例患儿肢体轻瘫,康复治疗半年基本恢复正常生活、学习;其余36例疗效满意,认知力、理解力正常,肢体功能恢复好,生活自理能力好。结论儿童对颅脑损伤开颅手术耐受力差,极易造成失血性休克、内环境紊乱,开颅风险高于成人。对伴有血肿的急性颅脑损伤患儿,行CT定位辅助锥颅穿刺软通道引流术,创伤小,恢复快,能够减少患儿的风险与痛苦,并可取得优良的疗效。Objective To explore the clinical efficacy of CT-guided cranial puncture and drainage for pediatric acute traumatic intracranial hematomas.Methods The clinical data of 42 children with acute traumatic intracranial hematomas treated from May 2016 to October 2021 were retrospectively analyzed.Results Twenty-six patients had epidural hematomas with a mean hematoma volume of(25.5±5.53)ml.Twelve patients had cerebral contusion and laceration complicated with intracerebral hematoma with a mean hematoma volume of(20.25±2.2)ml.Four patients had hematoma in basal ganglia with a mean hematoma volume of(20.75±2.38)ml.Cranial puncture and drainage under CT guidance was performed in all 42 children for 2~5 days with a drainage volume of 20~60 ml.All 42 patients were discharged from hospital without intracranial infection,delayed hemorrhage,seizure and other complications.On discharge,6 patients had limb palsy,which was returned to normal after rehabilitation treatment for half a year,and the other 36 patients had satisfactory curative effect,normal cognition and understanding,good recovery of limb function,and good self-care ability.Conclusions Children have poor tolerance to craniotomy for traumatic brain injury,which is easy to cause hemorrhagic shock and internal environment disorder,and the risk of craniotomy is higher than that of adults.For children with acute traumatic brain injury accompanied by hematoma,Cranial puncture and drainage assisted with CT positioning is less traumatic,faster recovery,and can reduce the risk and pain of children,and can obtain excellent curative effect.

关 键 词：急性颅脑损伤 颅内血肿 锥颅引流术 儿童 

分 类 号：R726.5[医药卫生—儿科]