颅脑损伤术中或术后迟发性颅内血肿临床分析

目的]探讨颅脑损伤术中或术后非手术区迟发性颅内血肿的发生规律、诊断和治疗.方法]回顾性分析16例颅脑外伤术后经CT检测或再次开颅探查证实术后非手术区迟发性颅内血肿的发生部位发生时间及其与脑挫裂伤、颅骨骨折等原发伤的关系,并采取相应的治疗措施.结果]血肿发生部位与手术部位关系:邻近型4例、远隔型6例、对侧型6例;发生在幕上15例,幕下1例;硬膜外血肿8例,脑内血肿5例,硬膜下血肿1例,硬膜下伴脑内血肿2例;再次手术11例,其中良好5例,中残2例,重残1例,死亡2例:保守治疗5例,其中痊愈3例,中残2例.结论]颅脑损伤术中或术后迟发性颅内血肿中,硬膜外、硬膜下与脑内血肿形成机制不尽相同,颅骨骨折、脑挫裂伤、脑膜或皮质血管破裂、桥静脉断裂等局部损伤影响不同类型血肿的形成,脑血管麻痹、低氧血症等是非手术区迟发性血肿形成的病理基础.及时CT检查和密切临床观察为其预后的关键.

Clinical Analysis of the Post-operative Delayed Intracranial Hematomas in Patients with Craniocerebral Trauma

Objective]To investigate the regularity of delayed intracranial hematomas in non-operative field after operations for craniocerebral trauma. Methods]Sixteen craniocerebral trauma patients with delayed intracranial hematomas after operation were investigated. The location and the time of delayed intracranial he- matoma in non-operation area, and the relationship between the contusion and laceration of brain , the skull fracture and other primary injuries were retrospectively analyzed. Resuhs]Four cases of delayed intracranial hematomas occurred closely to the operative field,6 cases far away from the operative field and 6 cases on the contralateral hemisphere; 15 cases occurred above tentorium, only 1 case below tentorium. There were extradural hematomas in 8 cases,intracerebral hematoma in 5 cases, subdural hematoma in 1 case,and both intracerebral and infradural hematomas in 2 cases. Among them, 11 cases were performed operations once again, and 5 cases cured,2 cases resulted in moderate disability, 1 case resulted in severe disability, 2 cases died. There were 5 cases treated by medicine, 3 cases acquired complete rehabilitation and 2 cases resulted in moderate disability. Conclusion]There is different pathogenesis in the delayed intracranial hematomas in non-operation area. The skull fracture, contusion and laceration of brain,angiorrhexis of meninges or cortex, rupture of bridging vein could distinctly play a role in these delayed hematomas. Vasoparalysis and hypoxemia are the pathologic basis for the formation of delayed intracranial hematoma in the non-operative field. Better CT scan in time and close clinical observation are the key points for prognosis.