儿童创伤性骑跨横窦硬膜外血肿微创治疗体会并文献复习  

Treatment Experience and Literature Review of Minimally Invasive Operation for Traumatic Epidural Hematoma Straddling Transverse Sinus in Children

作　　者：王亚琼[1] 娄丹[1] 唐艳[1] 刘梦娜 卢亚亚[1] 朱义通 杨家发 陆兆丰[2] WANG Yaqiong;LOU Dan;TANG Yan;LIU Mengna;LU Yaya;ZHU Yitonbg;YANG Jiafa;LU Zhaofeng(Department of Pediatric Rehabilitation,the First Afiliated Hospital of Henan University of Science and Technology/Clinical Medical College of Henan University of Science and Technology,Luoyang 471001,China;Emergency Department,the First Afiliated Hospital of Henan University of Science and Technology/Clinical Medical College of Henan University of Science and Technology,Luoyang 471001,China)

机构地区：[1]河南科技大学第一附属医院/河南科技大学临床医学院儿童康复科,河南洛阳471001 [2]河南科技大学第一附属医院/河南科技大学临床医学院急诊科,河南洛阳471001

出　　处：《河南医学研究》2025年第2期204-208,共5页Henan Medical Research

基　　金：河南省医学科技攻关省部共建重点项目(SBGJ202102198);河南省科技攻关项目(212102310678);河南省医学教育研究项目(Wjlx2021389);洛阳市核心技术攻关类公益专项重点项目(2302006A)。

摘　　要：目的 探讨儿童创伤性骑跨横窦硬膜外血肿(TEHSTS)的临床特点和微创治疗方法。方法 回顾性研究,选取2005年1月至2022年11月河南科技大学第一附属医院保守治疗无效的69例TEHSTS患儿行CT引导下的改良钻孔引流手术,并结合万方及PubMed数据库对其疗效进行分析。结果 69例TEHSTS患儿中男44例,女25例,年龄(9.1±3.2)岁,术前格拉斯哥昏迷评分(GCS)(12.0±1.5)分,以头痛、恶心及呕吐入院,手术前血肿体积为(24.5±4.5)mL,手术时间为伤后(15.4±2.2) h,均于局部浸润麻醉下行血肿改良钻孔引流手术,无转为开颅手术病例,手术时间(10.2±1.5)分。术后1 d GCS(14.5±0.5)分较术前提高(P<0.01),头痛、恶心及呕吐症状明显缓解。术后拔出引流管时间为(1.5±0.5)d,无术后短期并发症,术后住院时间为(8.2±1.2)d,术后随访时间为(6.5±0.5)个月,格拉斯哥预后评分(GOS)均恢复良好(5分)。检索到17篇微创手术治疗TEHSTS的文献,治愈率67%~100%,仅1组在64%以下。结论 CT定位引导下的改良钻孔引流术治疗儿童TEHSTS有其安全、有效、简便及微创的优点,可作为多数患儿的首选术式。Objective To investigate the clinical features and minimally invasive treatment of traumatic epidural hematoma straddling transverse sinus(TEHSTS)in children.Methods A retrospective study.From January 2005 to November 2022,69 children with TEHSTS who did not respond to conservative treatment in the First Affliated Hospital of Henan University of Science and Technology underwent CT-guided modified drlling and drainage surgery,and combined with Wanfang and PubMed databases,their efficacy was analyzed.Results Among the 69 children with TEHSTS,44 males and 25 females,aged(9.1±3.2)years,scored preoperative GCS score(12.0±1.5)points,were admitted to the hospital with headache,nausea and vomiting,the volume of hematoma before surgery was(24.5±4.5)mL,the average operation time was(15.4±2.2)hours after injury,and all underwent hematoma modified drilling and drainage surgery under local infiltration anesthesia,and there were no cases of craniotomy.The operation time(10.2±1.5)minutes.The GCS score(14.5±0.5)points at one day after surgery was significantly higher than that before surgery(P<0.01),and the symptoms of headache,nausea and vomiting were significantly relieved.The time to remove the drain after surgery was(1.5±0.5)days.There were no short-term postoperative complications.The length of postoperative hospital stay was(8.2±1.2)days.The postoperative follow-up period was(6.5±0.5)months,and all GOS recovered well(5 points).Retrieved 17 literature on minimally invasive surgery for TEHSTS,the cure rate was 67%-100%,and only one group was below 64%.Conclusion The modified drling and drainage under CT positioning guidance for the treatment of TEHSTS in children has the advantages of safety,effectiveness,simplicity and minimally invasive,and can be used as the first choice for most children.

关 键 词：创伤性骑跨横窦硬膜外血肿 儿童 改良钻孔引流术 效果 

分 类 号：R726.5[医药卫生—儿科]