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

[1]	Hilmer LV, Park KB, Vycheth I, et al. Cerebral contusion: an investigation of etiology, risk factors, related diagnoses, and the surgical management at a major government hospital in Cambodia[J]. Asian J Neurosurg, 2018, 13(1): 23-30.
[2]	Whitaker-Lea WA, Valadka AB. Acute management of moderate-severe traumatic brain injury[J]. Phys Med Rehabil Clin N Am, 2017, 28(2): 227-243.
[3]	吴喜，李智强，额布,等.改良大骨瓣减压术在部分额颞脑挫裂伤中的应用(附112例报告)[J].中华神经外科杂志, 2018, 34(12): 1266-1267.
[4]	刘窗溪，林浩，蒲天佑,等.显微神经外科手术中微创理念的践行[J].中华神经创伤外科电子杂志, 2020, 6(4): 248-250.
[5]	Cohen-Gadol AA. The art of microneurosurgery and passion for technical excellence[J]. J Neurosurg, 2018, 130(3): 1023-1027.
[6]	Khellaf A, Khan DZ, Helmy A. Recent advances in traumatic brain injury[J]. J Neurol, 2019, 266(11): 2878-2889.
[7]	Stocchetti N, Carbonara M, Citerio G, et al. Severe traumatic brain injury: targeted management in the intensive care unit[J]. Lancet Neurol, 2017, 16(6): 452-464.
[8]	Carney N, Totten AM, O’Reilly C, et al. Guidelines for the management of severe traumatic brain injury, fourth edition[J]. Neurosurgery, 2017, 80(1): 6-15.
[9]	Salehi A, Zhang JH, Obenaus A. Response of the cerebral vasculature following traumatic brain injury[J]. J Cereb Blood Flow Metab, 2017, 37(7): 2320-2339.
[10]	谭博，闫瑞妹，刘绍明.显微手术配合去骨瓣减压治疗额及颞叶脑挫裂伤的疗效[J].中华神经外科疾病研究杂志, 2016, 15(3): 261-262.
[11]	Savardekar AR, Patra DP, Narayan V, et al. Incidence, pathophysiology, and prevention strategies for cerebral venous complications after neurologic surgery: a systematic review of the literature[J]. World Neurosurg, 2018, 119: 294-299.
[12]	张尚明，刘海兵，王守森.经单侧入路双侧额叶脑挫裂伤清除术[J].中华神经创伤外科电子杂志, 2018, 4(2): 125-127.
[13]	刘海兵，魏梁锋，王守森,等.双侧额叶脑挫裂伤经单侧开颅显微镜下手术体会[J].中国微侵袭神经外科杂志, 2016, 21(7): 315-316.
[14]	陈雄辉，张鹏杰，徐峰,等.颅脑创伤术中出现急性脑膨出的原因分析及救治措施[J].创伤外科杂志, 2018, 20(10): 760-762.

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