脑外伤开颅术后纵裂分离型硬膜下积液诊治分析

目的探讨脑外伤开颅术后出现纵裂分离型硬膜下积液产生的原因和治疗方法。 方法回顾性分析解放军第九四医院神经外科自2013年1月至2016年12月收治的22例脑外伤开颅术后出现纵裂分离型硬膜下积液的患者，通过高压氧、弹力绷带加压包扎、钻孔引流术、腰大池置管引流等治疗方法，观察积液减少情况。 结果纵裂分离型硬膜下积液患者均通过弹力绷带加压包扎联合高压氧治疗2周后，仅14例患者复查颅脑CT示积液有不同程度减少；3例经钻孔引流术或Ommaya囊抽液治疗有效，3例经腰椎穿刺或腰椎持续引流治疗有效，2例经积液-腹腔分流术治疗有效，8例患者行脑室-腹腔分流术治疗有效。 结论临床针对纵裂分离型硬膜下积液患者应根据头颅CT或MRI估计积液量，结合患者的病情采用恰当的方法治疗能取得良好的治疗效果。

Diagnosis and treatment of longitudinal subfissure subdural effusion after craniotomy for traumatic brain injury

ObjectiveTo investigate the causes, diagnosis and treatment of subdural effusion after longitudinal craniotomy. MethodsA retrospective analysis of 22 patients with subdural effusion after craniotomy was treated by hyperbaric oxygen, elastic bandage pressure bandage, drilling drainage, and large pool drainage. ResultsAfter 2 weeks with elastic bandage compression bandage combined with hyperbaric oxygen for 2 weeks, only 14 patients rechecked the craniocerebral hematocerebral effusion in different degrees; 3 cases were effectively treated by drilling drainage or Ommaya sac, 3 cases were treated with lumbar puncture or lumbar continuous CET, and 2 cases were effusion-abdominal shunt Operative treatment was effective, and 8 patients received ventriculoperitoneal shunt. ConclusionThe patients with longitudinal split type subdural effusion should estimate the amount of effusion according to the head CT or MRI, and a proper method of treatment combined with the patient's condition can achieve good therapeutic effect.