单、双侧大骨瓣减压治疗外伤性弥漫性脑肿胀伴颅内血肿的临床研究.docVIP

精品论文 参考文献 单、双侧大骨瓣减压治疗外伤性弥漫性脑肿胀伴颅内血肿的临床研究 熊章盛１　蒋太鹏２　司　文１　李庆龙１　陈彩英１ 　　１．广东省深圳市龙华新区中心医院(广东医学院附属医院)神经外科　深圳　５１８１１０;２．广东省深圳市第二人民医院(深圳大学附属医院)神经外科　深圳　５１８１１０ 广东省深圳市龙华新区２０１３年科技创新基金资助课题作者简介:熊章盛,男,出生年月:１９８０－７;学历:本科,主治医师,从事神经外科方面研究.【摘要】　目的　比较单、双侧标准大骨瓣减压治疗外伤性弥漫性脑肿胀伴颅内血肿的疗效差异.方法　回顾性分析我院自２００６年２月~２０１２年３月因创伤性急性弥漫性脑肿胀伴颅内血肿急诊行标准外伤大骨瓣减压手术４３例的临床资料,其中双侧标准外伤大骨瓣减压手术２３例、单侧标准外伤大骨瓣减压手术２０例.比较两者在CT分级、术后并发症及术后６个月格拉斯哥预后分级(GlasgowOutcomeScale,GOS)的区别.结果　根据LiuCT分级,双侧组患者术后中脑及环池受压缓解率明显优于单侧组;术中出现恶性脑膨出及术后出现骨窗疝伴脑梗塞方面低于单侧组;术后随访６个月,根据GOS预后分级,双侧组恢复良好率(４７．８２％)明显高于单侧组(１５．０％);双侧组死亡率(４．３４％)明显低于单侧组(３５．０％),以上差异均有统计学意义(P＜０．０５).结论　双侧标准外伤大骨瓣减压手术在治疗创伤性急性弥漫性脑肿胀伴颅内血肿方面具有显著优越性,能够降低患者病死率,提高生存质量,是治疗该疾病的一种较好的手术方法. 【关键词】　颅脑损伤;　外伤性弥漫性脑肿胀;　颅内血肿;　标准大骨瓣减压;　预后 　　【Abstract】　ObjectiveTocomparetheoutcomesbetweentheunilateralandbilateralstandardtraumacraniotomyintreatmentofthepost－traumaticacutediffusebrainswelling(PADBS)patientswithtraumaticintracranialhematoma．MethodRetrospectiveanalysisof４３patients,whohadPADBSwithtraumaticinＧtracranialhematomaandtookenmergencyoperationsofstandardtraumacraniotomy ,from February２００６toMarch２０１２ .Allpatientsweredividedintotwogroup:bilateralgroupincludingoftwenty－threepatientstakingoperationsofbilateralstandardtraumacraniotomyandunilateralgroupwhichmanagedbyunilatＧeralmethods.ResultsAfteroperating,accordingtoLiuCTclassification,bilateragroupwasobviouslysuperiortotheunilateralgroupinreleasingtheintracranialhypertensionagainstthemidbrainandcisternaambiens,thedifferencesmadestatisticalsense;Theratesofcenencephaloceleandbrainherniaoccurredinbilateralgroupweresignificantlylowerthanthatinunilateralgroup.Therateofgoodrecoveringinbilateralgroup(４７．８２％)wassignificantlybetterthanthatinunilateralgroup(１５．０％)accordingtoGlasgowoutcomescore(GOS)aftertheoperationandthenext６months．Therateofmortalityinbilateralgroup(４．３４％)wassignifiＧcantlylowerthanthatinunilateralgroup(３５．０％)．Thedifferenceshadstatisticalsignificance(P ＜ ０．０５ )ConclusionBilateralstandardtraumacraniotomyofPADBSwithtraumaticintracranialhematomahadremark