显微外科手术治疗复杂性脑挫裂伤

doi:10.3877/cma.j.issn.2095-9141.2021.01.005

中华神经创伤外科电子杂志 ›› 2021, Vol. 07 ›› Issue (01) : 21 -24. doi: 10.3877/cma.j.issn.2095-9141.2021.01.005

所属专题：文献；

颅脑损伤

显微外科手术治疗复杂性脑挫裂伤

黄银兴¹, 刘峥¹, 陈其钻¹, 张尚明¹, 田君¹, 薛亮¹, 王守森¹^,^†(

)

^1. 350025　福州，联勤保障部队第九〇〇医院神经外科

收稿日期:2020-12-28 出版日期:2021-02-15
通信作者: 王守森
基金资助:
联勤保障部队第九〇〇医院院立课题(2018Z03、2020Z04)

Microsurgery in the treatment of complex cerebral contusion and laceration

Yinxing Huang¹, Zheng Liu¹, Qizuan Chen¹, Shangming Zhang¹, Jun Tian¹, Liang Xue¹, Shousen Wang¹^,^†()

^1. Department of Neurosurgery, 900th Hospital of Joint Service Support Force, Fuzhou 350025, China

Received:2020-12-28 Published:2021-02-15
Corresponding author: Shousen Wang

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目的

分析显微外科手术治疗复杂性脑挫裂伤的手术经验及疗效。

方法

回顾性分析联勤保障部队第九〇〇医院神经外科自2018年1月至2020年12月收治的45例接受显微镜下复杂性脑挫裂伤清除术患者的临床资料。

结果

单侧开颅清除单侧脑挫裂伤者27例，双侧开颅清除双侧脑挫裂伤者11例，单侧开颅行双侧额叶脑挫裂伤清除术者4例，双侧脑挫裂伤行单侧脑挫裂伤清除术者3例。血肿完全清除者18例，少量残留者17例，部分残留者10例。术后血肿再发1例，死亡1例。随访3~6个月后，GOS评分恢复良好者26例，中等残疾者8例，重度残疾者6例，植物状态者4例。

结论

显微手术有助于彻底清除血肿，充分减压，并减少不必要的损伤，降低术后并发症风险。

关键词: 复杂性脑挫裂伤, 重型颅脑损伤, 显微外科手术

Objective

To analyze and summarize the experience and curative effect of microsurgery in the treatment of complex cerebral contusion and laceration.

Methods

The clinical data of 45 patients with complex cerebral contusion and laceration who underwent microsurgery in Neurosurgery Department of 900^th Hospital of Joint Service Support Force from January 2018 to December 2020 were retrospectively analyzed.

Results

Unilateral craniotomy for unilateral contusion and laceration in 27 cases, bilateral craniotomy for bilateral contusion and laceration in 11 cases, unilateral craniotomy for bilateral frontal lobe contusion and laceration in 4 cases, and 3 cases with bilateral contusion were treated with unilateral evacuation of hematoma. The hematoma was completely removed in 18 cases, a small amount remained in 17 cases, and a partial residual in 10 cases. Postoperative hematoma recurred in 1 case and died in 1 case. After 3-6 months of follow-up, it is found that 26 cases recovered well with good GOS score, 8 cases had moderate disability, 6 cases had severe disability and 4 cases with vegetative state.

Conclusion

Microsurgery helps surgeon to completely remove the hematoma, adequately decompress intracranial pressure, reduce unnecessary iatrogenic injury, and reduce the risk of postoperative complications.

Key words: Complex cerebral contusion and laceration, Severe traumatic brain injury, Microsurgery

图1 复杂脑挫裂伤患者术前术后临床资料

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