切换至 "中华医学电子期刊资源库"

中华神经创伤外科电子杂志 ›› 2018, Vol. 04 ›› Issue (06) : 341 -343. doi: 10.3877/cma.j.issn.2095-9141.2018.06.006

所属专题: 文献

临床研究

经皮穿刺引流术治疗开颅去骨瓣减压术后硬膜下积液的疗效分析
李春虎1, 靳洪波2, 郑全乐1,(), 周顺义1, 张家瑞1   
  1. 1. 065000 廊坊,爱德堡医院神经外科
    2. 050051 石家庄市第二医院神经外科
  • 收稿日期:2018-06-18 出版日期:2018-12-15
  • 通信作者: 郑全乐
  • 基金资助:
    河北省医学科学研究重点指令性课题(20170214)

Treatment of percutaneous drainage for subdural effusion after decompressive craniectomy

Chunhu Li1, Hongbo Jin2, Quanle Zheng1,(), Shunyi Zhou1, Jiarui Zhang1   

  1. 1. Department of Neurosurgery, Edburg Hospital, Langfang 065000, China
    2. Department of Neurosurgery, Shijiazhuang Second Hospital, Shijiazhuang 050051, China
  • Received:2018-06-18 Published:2018-12-15
  • Corresponding author: Quanle Zheng
  • About author:
    Corresponding author: Zheng Quanle, Email:
引用本文:

李春虎, 靳洪波, 郑全乐, 周顺义, 张家瑞. 经皮穿刺引流术治疗开颅去骨瓣减压术后硬膜下积液的疗效分析[J]. 中华神经创伤外科电子杂志, 2018, 04(06): 341-343.

Chunhu Li, Hongbo Jin, Quanle Zheng, Shunyi Zhou, Jiarui Zhang. Treatment of percutaneous drainage for subdural effusion after decompressive craniectomy[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2018, 04(06): 341-343.

目的

探讨经皮穿刺引流术治疗开颅去骨瓣减压术后硬膜下积液的疗效分析。

方法

选择爱德堡医院神经外科自2008年8月至2018年5月收治的60例开颅去骨瓣减压术后硬膜下积液患者为研究对象。根据患者病情及其家属意愿将采用经皮穿刺引流术治疗的患者设为观察组(30例),采用腰椎穿刺引流术治疗的患者设为对照组(30例),比较2组患者的治疗总有效率、治愈时间以及并发症的发生情况。

结果

同对照组治疗总有效率(70.00%)比较,观察组的治疗总有效率(96.67%)获得明显提升(P<0.05)。对照组治愈时间为(12.69±2.13)d,观察组治愈时间为(7.78±1.24)d,观察组明显短于对照组(t=8.912,P=0.000)。2组患者术后均未发生颅内积气及感染,对照组出现穿刺点脑脊液漏3例,观察组出现头皮切口漏液2例,对症处理后均消失,差异无统计学意义(P>0.05)。

结论

开颅去骨瓣减压术后硬膜下积液患者选择经皮穿刺引流术治疗,可以获得明显减压效果。

Objective

To explore the efficacy of percutaneous drainage in the treatment of subdural effusion after decompressive craniectomy.

Methods

Sixty patients with subdural effusion after decompression craniotomy in our hospital from August 2008 to May 2018 were selected as experimental subjects. According to the wishes of patients and their families, the patients treated by percutaneous drainage were set as observation group (30 cases), and the patients treated by lumbar puncture drainage were set as control group (30 cases). The total effective rate, healing time and complications of the two groups were compared.

Results

Compared with the control group, the total effective rate was significantly increased in the observation group (70.00% vs. 96.67%, P<0.05). The healing time of the observation group was shorter than that of the control group [(7.78±1.24) d vs. (12.69±2.13) d], the difference was statistically significant (t=8.912, P=0.000). No intracranial gas accumulation or infection occurred in both 2 groups. There were 3 cases of cerebrospinal fluid leakage at the puncture site in the control group and 2 cases of scalp incision leakage in the observation group, all of which disappeared after the treatment of the disease, and the difference was not statistically significant (P>0.05).

Conclusion

Subdural effusion after decompression with craniotomy and osteotomy can be significantly reduced by percutaneous drainage.

表1 2组开颅去骨瓣减压术后硬膜下积液患者治疗总有效率比较
[1]
Sakamoto H, Matsusaka Y, Kunihiro N, et al. Physiological changes and clinical implications of syndromic craniosynostosis[J]. J Korean Neurosurg Soc, 2016, 59(3):204-213.
[2]
马继强,贾锋,梁玉敏,等.重型颅脑损伤患者去骨瓣减压术后并发对侧硬膜下积液的处理[J].山东医药, 2015, 55(34):56-57.
[3]
赵爱国.颅骨修补对颅脑创伤患者去骨瓣减压术后并发对侧硬膜下积液的临床意义[J].中华神经外科杂志, 2014, 30(3):257-259.
[4]
于培通,李奉强,李鹏.低张力弹力绷带包扎预防去骨瓣减压术后硬膜下积液发生的临床研究[J].实用临床医药杂志, 2015, 19(15):121-122.
[5]
陈志斌,黄祜鸿,宋海鹏.外伤后硬膜下积液向硬膜下血肿转化的相关因素分析[J].实用临床医药杂志, 2016, 20(11):191-192.
[6]
范文斌,王娜,王海燕,等. Ommaya囊置入外引流术对小儿难治性硬膜下积液的疗效评价[J].重庆医学, 2016, 45(8):1096-1098.
[7]
Makarenko S, Carreras EM, Akagami R. Craniotomy for perisellar meningiomas: comparison of simple (appropriate for endoscopic approach) versus complex anatomy and surgical outcomes[J]. J Neurosurg, 2017, 126(4):1191-1200.
[8]
Sandler AL, Goodrich JT, Daniels LB, et al. Craniocerebral disproportion: a topical review and proposal toward a new definition, diagnosis, and treatment protocol[J]. Childs Nerv Syst, 2013, 29(11):1997-2010.
[9]
黄志伟,何绍伟,戴先前.颅脑损伤去骨瓣减压术后硬膜下积液的治疗分析[J].中国临床神经外科杂志, 2015, 20(8):501-502.
[10]
Elmalem VI, Palazzolo L, Akanda M. Optic Nerve, Visual pathways, oculomotor system, and consequences of intracranial injury[M]. Textbook of Ocular Trauma. Cham: Springer, 2017: 169-250.
[11]
陈洁,李芹.无乳链球菌感染致新生儿化脓性脑膜炎并硬膜下积液1例报告[J].临床儿科杂志, 2014, 32(7):658-659.
[12]
于培通,李奉强,李鹏.低张力弹力绷带包扎预防去骨瓣减压术后硬膜下积液发生的临床研究[J].实用临床医药杂志, 2015, 19(15):121-122.
[13]
李战义,吕荣乾,翟晓慧,等.外伤性硬脑膜内积液和水瘤(附41例临床分析)[J].中华神经外科杂志, 1995, 11(2):113-114.
[14]
惠鲁生,席炜滨,黄伟,等.去骨瓣减压术后张力性硬膜下积液的治疗和预防[J].中国临床神经外科杂志, 2014, 19(11):691-693.
[15]
肖阳,张永明.腰大池引流在开颅去骨瓣减压术后硬膜下积液中的应用[J].中国实用神经疾病杂志, 2014, 17(12):76-77.
[1] 李甲, 沈罡, 朱光耀, 陈茂送, 王波定. 大面积脑梗死去骨瓣减压术后迟发性脑过度灌注综合征的危险因素分析[J]. 中华危重症医学杂志(电子版), 2022, 15(02): 111-117.
[2] 冷昭富, 汪永新. 儿童去骨瓣减压术后颅骨成形术的研究进展[J]. 中华神经创伤外科电子杂志, 2023, 09(05): 313-317.
[3] 郭鹏, 李锦平. 去骨瓣减压术后与颅骨缺损相关的并发症及其防治[J]. 中华神经创伤外科电子杂志, 2023, 09(02): 119-122.
[4] 周智, 王飚, 雷军, 黄弋洋, 汤秉洪, 毛磊. 去骨瓣减压术后硬膜下积液的治疗措施分析[J]. 中华神经创伤外科电子杂志, 2022, 08(01): 44-46.
[5] 魏宜功, 周焜, 陈光唐, 王诚, 刘窗溪. 颅内压监测下改良阶梯减压法结合去骨瓣减压治疗颅内高压的疗效分析[J]. 中华神经创伤外科电子杂志, 2022, 08(01): 28-33.
[6] 龙腾, 邓义俊, 杨承勇, 杨恒, 杨媛, 施辉亚, 熊云彪, 刘窗溪. 一期钛网修补治疗去骨瓣减压术后脑切口覃状疝一例报道并文献复习[J]. 中华神经创伤外科电子杂志, 2021, 07(06): 380-382.
[7] 张尚明, 胡晓芳, 赵琳, 陈宏颉, 魏梁锋, 王守森. 外伤性脑疝患者去骨瓣减压术中并发脑膨出的预测因素[J]. 中华神经创伤外科电子杂志, 2021, 07(06): 339-344.
[8] 田润发, 董金千, 刘伟明, 卢盛华, 杨梦石, 张斌, 高飞, 庄园, 葛芊芊, 徐晓健, 牛非, 刘佰运. 颅脑外伤后无瞳孔散大患者行去骨瓣减压术后的早期结果及出院死亡率的预后相关因素分析[J]. 中华神经创伤外科电子杂志, 2021, 07(02): 75-81.
[9] 王洪伟, 张剑宁, 皇甫罗凯, 康建刚. 硬膜下积液治疗经验总结(附27例临床分析)[J]. 中华神经创伤外科电子杂志, 2020, 06(05): 299-303.
[10] 高国一. 颅脑创伤难治性并发症[J]. 中华神经创伤外科电子杂志, 2020, 06(04): 193-195.
[11] 田志华, 茹小红, 李敏, 段海锋, 张浩, 黄可丰. 去骨瓣减压术后合并脑膨出早期颅骨修补策略[J]. 中华神经创伤外科电子杂志, 2020, 06(03): 176-179.
[12] 吕学明, 赵振宇, 初晨宇, 孙新同, 卢培刚, 袁绍纪. 双额去骨瓣减压术治疗双侧额叶挫裂伤致中央型脑疝的临床报告[J]. 中华神经创伤外科电子杂志, 2020, 06(02): 110-112.
[13] 何永昌, 杨建军, 崔阳, 王丹妹, 封立彬, 智天鹏, 尹连虎. 重型颅脑损伤开颅大骨瓣减压术后并发硬膜下积液的治疗和分析[J]. 中华神经创伤外科电子杂志, 2019, 05(06): 365-369.
[14] 王如海, 孙菲琳, 杨震, 韩超, 于强, 胡海成. 硬膜下积液厚度对创伤性硬膜下积液转化为慢性硬膜下血肿的预测价值[J]. 中华脑科疾病与康复杂志(电子版), 2021, 11(04): 227-231.
[15] 刘性强, 王文豪, 白映红, 李斌, 杨凯, 王智, 魏书田. 颅脑创伤去骨瓣减压术后低颅压脑积水[J]. 中华脑科疾病与康复杂志(电子版), 2020, 10(02): 110-113.
阅读次数
全文


摘要