小儿急性外伤性硬膜下血肿快速消退19例临床分析

目的探讨小儿急性外伤性硬膜下血肿快速消退的临床特点及可能机制。方法对1996年9月～2006年9月收治的19例快速自行消退的急性硬膜下血肿患儿的临床资料进行回顾性分析。结果男11例。女8例；年龄4个月～14岁，平均6．5岁。入院时GCS评分9～15分，均于伤后3h内CT证实为急性硬膜下血肿，血肿量约10～30ml。经保守治疗。头颅CT动态观察。血肿于伤后12h内消退者9例，～24h者6例，～72h者4例。结论脑脊液经撕裂的蛛网膜冲洗血肿．使之得以稀释扩散及重新分布，导致急性硬膜下血肿快速消退。脑血管搏动的去纤维化作用、颅骨骨折伴硬脑膜撕裂、颅缝与囟门未完全闭合、适当增高的颅内压等也有助于血肿快速消退。     

微创软通道穿刺引流术治疗小儿急性外伤性硬膜下血肿16例临床分析

目的 探讨小儿颅脑损伤后急性硬膜下血肿行微创软通道穿刺引流术的治疗方法.方法 回顾性分析2003年1月至2010年12月16例行微创软通道穿刺引流术治疗患儿的临床资料,总结此手术治疗方法的适应证和可行性.结果 16例患儿通过微创软通道穿刺引流术治疗效果好,患儿症状明显好转,预后理想.结论 微创软通道穿刺引流术治疗小儿急性单纯硬膜下血肿方法简便,能迅速起效,利于急诊急救.     

前囟穿刺持续引流治疗婴儿外伤性硬膜下血肿

为提高婴儿外伤性硬膜下血肿的治愈率，采用采囱穿刺持续引流治疗婴儿硬膜下血肿２３例，并根据每日引流量补充等量０．９％氯化内溶液，经随访３至１１个月，效果较满意，头部ＣＴ或ＭＲＩ复查，血肿消退大８０％，脑复位满意者１４例，占６０．９％，结论为血肿的吸收与及组织是否及时膨胀，血肿引流后的残腔能否及时间合有直接关系。     

前囟穿刺持续引流治疗婴儿外伤性硬膜下血肿

为提高婴儿外伤性硬膜下血肿的治愈率，采用前囟穿刺持续引流治疗婴儿硬膜下血肿２３例，并根据每日引流量补充等量０９％氯化钠溶液，经随访３至１１个月，效果较为满意，头部ＣＴ或ＭＲＩ复查，血肿消退大于８０％，脑复位满意者１４例，占６０９％。结论为血肿的吸收与脑组织是否及时膨胀，血肿引流后的残腔能否及时闭合有直接关系。     

颅骨钻孔引流治疗儿童亚急性硬膜下血肿60例

目的 探讨颅骨钻孔引流术对于治疗儿童外伤导致亚急性硬膜下血肿的临床疗效.方法 回顾分析60例因外伤导致亚急性硬膜下血肿,全组患儿均行颅骨钻孔引流术,其中有55例患儿术后行尿激酶生理盐水引流冲洗,术后随访2年以上,观察其疗效.结果 术后随访2年以上,59例均临床治愈,术后血肿完全消失55例,残留少量薄层血肿(＜5 mm)4例于术后3个月后吸收,7例合并存在脑挫裂伤出现局部脑软化随访无明显神经功能障碍,5例患儿出现外伤后癫痫内科药物治疗后临床治愈,2例出现轻度脑积水,1例出现脑疝死亡.结论 对于儿童外伤导致亚急性硬膜下血肿如对大脑产生压迫,深度超过1 cm,出现颅内压增高症状和体征时应进行外科治疗.颅骨钻孔引流术因手术创伤小,疗效好,大多数患儿预后较好.     

小儿外伤性硬膜下积液127例临床分析

目的 总结小儿外伤性硬膜下积液的病因、临床特征、诊断与治疗.方法 回顾性分析127例小儿外伤性硬膜下积液的临床特点、影像学资料和不同时期的治疗方法.结果 保守治疗后,86例在2周～3个月内积液完全消失,41例手术患儿1个月内积液减少,6个月内积液消失.结论 小儿外伤性硬膜下积液的诊断以临床表现和影像学资料为主,只要早期诊断、合理治疗,大部分保守治疗后恢复良好;对积液量多、症状明显者应及时手术引流,减少后遗症,提高疗效.     

硬膜下血肿术后便血呕血

病例介绍患儿 :男 ,14岁。半月前被车撞伤后 4ｈ在当地医院诊断为颅内出血 ,急诊行开颅手术。术中证实为硬膜下血肿 ,行血肿清除术。同时伴右肱骨外髁颈骨折 ,重度成角畸形 ,因当时病情危重 ,未做内固定手术。术后次日清醒 ,一周拆线 ,并离床活动。手术后第 11天无诱因出现腹部不适 ,继而排出大量柏油样便 ,伴呕血 1次 ,经非手术治疗 4ｄ ,共输血 480 0ｍｌ,仍出血不止。因反复大量出血而转入我院。入院后 10ｈ便血 3次 ,呕血 1次 ,呕吐血液为陈旧性与新鲜血混杂的血块。又输血 80 0ｍｌ,血压仍低 ,血红蛋白持续在 3ｇ/Ｌ以下 ,呈休克状态。…     

儿童脑积水可调压分流管分流术后硬膜下积液/血肿的临床分析

目的分析儿童脑积水可调压分流管分流术后硬膜下积液/血肿(SEHS)的临床资料, 为术后随访提供参考。方法回顾性研究。2017年8月至2021年9月于华中科技大学同济医学院附属武汉儿童医院神经外科使用可调压分流管治疗脑积水患儿共102例, 其中发生SEHS 16例。16例患儿中, 男11例, 女5例;年龄3个月～13岁, 平均2.5岁;总结这些患儿的年龄、临床表现、SEHS出现时间、治疗方式(单纯调压或联合钻孔引流)、预后情况等。调压治疗为每次调高10～20 mmH2O(1 mmH2O=0.009 8 kPa), 间隔2～4周复查, 如复查SEHS未减少, 则建议调压联合钻孔引流治疗。结果 16例患儿中, >3岁3例, ≤3岁13例。11例为单纯调高压力治疗, 5例需调高压力联合钻孔引流, 且年龄均≤3岁。2例出现症状:1例为呕吐, 另1例为头及肢体抖动;14例无症状。出现SEHS的时间距离分流手术时间:≤1个月者5例, 均通过单纯调高压力治愈;>1～3个月者5例, 2例需联合钻孔引流;>3～6个月者3例, 1例需联合钻孔引流;>6个月者3例, 2例需联合钻孔引流...     

双腔引流管引流治疗小儿慢性硬膜下血肿

慢性硬膜下血肿 (CSDH) ,指血肿存留2～3周以上 ,其表面有包膜形成 ,在小儿颅脑损伤中比较常见。我院自1997年3月至2001年11月共对28例小儿CSDH采用钻孔双腔引流管引流 ,效果显著 ,并发症少 ,现报告如下。临床资料男18例 ,女10例 ;年龄1岁5个月～9岁 ,平均6.2岁 ;病程最短16d ,最长3月。其中摔伤18例 ,不明原因2例 ,其他8例。血肿部位位于右侧12例 ,左侧11例 ,双侧5例。头痛、呕吐20例 ,嗜睡、精神不振6例 ,抽搐12例 ,视乳头水肿16例。所有28例患儿均经CT检查 ,中线结构移位20例 ,脑室受压变形18例。按照多田氏方程式计算血肿量(π6×长…     

小儿外伤性硬脑膜下积液的手术治疗

目的：探讨小儿外伤性硬膜脑下积液的外科治疗，同时介绍一种蛛网膜造瘘和颞肌堵塞的手术治疗方法。方法：12例外伤性硬膜脑下积液患儿中3例给予单纯钻孔引流术，3例在接受多次单孔引流术后因复发而接受蛛网膜造瘘颞骨堵塞手术，另6例患儿直接给予蛛网膜造瘘及颞肌堵塞手术治疗；蛛网膜造瘘及颞肌堵塞治疗的方法为：在基础及局麻下，于患侧颞部做4cm长深达骨膜的皮肤直切口牵开，颅骨钻孔一枚后扩大成直径为3cm的骨窗，电烙切开骨下的硬脑膜，缓慢放出硬脑下积液；在蛛网膜上做一小的撕裂口；制取术野2cm宽的带蒂颞肌瓣，做适当的剪裁延长并严密止血后，将其游离段经骨孔置入硬脑膜下腔并在骨窗处适当固定。结果：3例患儿在单纯钻孔引流术后一次治愈；3例经多次钻孔引流失败者及另6例患儿均在一次性蛛网膜造瘘及颞肌堵塞手术后治愈。结论：蛛网膜造瘘及颞肌堵塞术是一种治疗外伤性硬膜脑下积液的实用方法，其操作简单，并发症少，效果理想。     

小儿急性外伤性双侧硬膜外血肿

目的：观察小儿急性外伤性双侧硬膜外血肿的临床特点,分析其形成机制,探讨其早期诊断要点及有效的手术治疗方法。方法对收治的21例小儿急性外伤性双侧硬膜外血肿患者的临床、影像资料及预后进行分析。结果21例患儿年龄4个月～16岁,平均年龄6.88岁。其中双侧跨中线单个血肿5例,双侧不同部位2个及2个以上血肿16例。首次头部CT检查发现双侧血肿12例,另外9例通过复查发现迟发性血肿。患儿入院时格拉斯哥昏迷评分13～15分8例,9～12分11例,≤8分2例。手术治疗8例,其中行双侧手术7例,单侧手术1例;保守治疗13例。除1例死亡外,余患儿均恢复良好。结论一侧硬膜外血肿开颅手术后对侧迟发硬膜外血肿较难早期发现,易导致预后不良,动态CT扫描可及时发现双侧硬膜外血肿并观察到血肿的变化;小儿双侧硬膜外血肿早期发现并及时采取个体化治疗方能预后良好。     

Spontaneous development of bilateral subdural hematomas in an infant with benign infantile hydrocephalus: color Doppler assessment of vessels traversing extra-axial spaces

We present an infant with macrocrania, who initially demonstrated prominent extra-axial fluid collections on sonography of the brain, compatible with benign infantile hydrocephalus (BIH). Because of increasing macrocrania, a follow-up sonogram of the brain was performed; it revealed progressive enlargement of the extra-axial spaces, which now had echogenic debris. Color Doppler US showed bridging veins traversing these extra-axial spaces, so it was initially thought that these spaces were subarachnoid in nature (positive cortical vein sign). However, an arachnoid membrane was identified superior to the cortex, and there was compression of true cortical vessels beneath this dural membrane. An MRI of the brain showed the extra-axial spaces to represent bilateral subdural hematomas. The pathogenesis of spontaneous development of the subdural hematomas, in the setting of BIH, is discussed. We also emphasize that visualizing traversing bridging veins through extra-axial spaces does not necessarily imply that these spaces are subarachnoid in origin.     

小儿侧裂池蛛网膜囊肿伴发硬膜下血肿的手术治疗

目的 探讨小儿侧裂池蛛网膜囊肿伴发硬膜下血肿的临床特点、手术适应证和术式选择.方法 回顾性分析2005年7月至2015年8月,中国医科大学附属第一医院神经外科收治的50例小儿侧裂池蛛网膜囊肿伴硬膜下血肿患儿的临床资料,其中亚急性硬膜下血肿者20例,慢性硬膜下血肿者30例,所有患儿均行血肿清除、显微囊肿切除、脑池沟通术,术中尽可能全切囊肿壁,并与蛛网膜下腔、脑池相沟通.结果 所有患儿手术过程均较顺利,术后未出现严重并发症.患儿术后原有症状及影像学表现均有不同程度的改善,平均随访5.7年无复发病例.结论 小儿侧裂池蛛网膜囊肿可引发硬膜下血肿,一旦发生,适合行显微囊肿切除、脑池沟通、血肿清除术.     

小儿外伤性硬膜外血肿的诊断和治疗

为了准确地诊断和小儿外伤性硬膜外血肿。方法总结本院１９８５年１月－１９９５年１２月收治的小儿外伤性硬膜外血肿１９６例。结果发现１５８例患儿有轻、中度意识障碍（１５－１３分１０６例,１２－９分５２例）,１８９例有头痛,呕吐,１７９例存在贫血貌,少有典型的中间清醒期,３８例在严重继发性脑损伤后出现神经系统损害的体征。     

婴幼儿硬脑膜外血肿

目的：探讨婴幼儿硬脑膜外血肿的临床特点。方法回顾性分析了我院近3年来收治的婴幼儿硬脑膜外血肿18例。占同期儿童(15岁以下)硬脑膜外血肿的15％，年龄最小为5个月，全部患儿均行CT或X线平片检查确诊。结果受伤原因以坠落伤为主，血肿部位以顶、枕为主。10例(55．6％10／18)患儿合并有颅骨骨折，原发昏迷者仅1例，所有患儿均有呕吐。除急诊手术者外，其他于首次发现血肿1d后及2～3d左右再复查CT。手术者占50％，发现大多数血肿来源于硬脑膜表面微小血管出血。结论：硬脑膜剥离致表面微小血管出血为婴幼儿硬膜外血肿形成的首要原因，有必要行多次CT检查，治疗恰当则预后良好。     

Clinical feature analysis of subdural effusion/hematoma after shunt use of adjustable valves in children with hydrocephalus北大核心CSCD

Objective To analyze the clinical data of children with hydrocephalus suffering from subdural effusion/hematoma after shunt(SEHS) with adjustable valves, and to provide reference for postoperative follow - up. Methods A total of 102 children with hydrocephalus treated with adjustable valves in the Department of Neurosurgery, Wuhan Children's Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology from August 2017 to September 2021 were enrolled and studied retrospectively. There were 16 cases with SEHS, 11 of whom were male and 5 were female. The age ranged from 3 months to 13 years (median;2. 5 years). The age, clinical manifestations, the time of SEHS occurrence, treatment methods (pressure regulation only or combined with drilling and drainage), and prognosis of the patients were analyzed. The pressure adjustment treatment was to increase the by 10-20 mmH2O (1 mmH2O =0.0098 kPa) each time and the patients were followed up 2-4 weeks after the adjustment. If SEHS didn't improve according to the follow - up results, pressure regulation combined with drilling and drainage was recommended. Results Of the 16 patients with SEHS, 3 cases were over 3 years old, and the other 13 cases were 3 years old or below. Eleven cases were treated by pressure regulation only, and 5 cases who were all aged 3 years received pressure regulation combined with drilling and drainage. Symptoms occurred in 2 patients, including vomiting in 1 case, and head and limb shaking in the other case. Fourteen cases were asymptomatic. The time from shunt operation to the occurrence of SEHS was 1 month in 5 cases, who were all cured by pressure regulation only. SEHS occurred in 5 cases > 1-3 months after shunt surgery, and 2 cases of them were treated by pressure regulation combined with drilling and drainage. Three cases had SEHS > 3-6 months after shunt surgery, and 1 case of them was treated by pressure regulation combined with drilling and drainage. SEHS occurred in 3 cases more than 6 months after shunt surgery, and 1 case of them was treated by pressure regulation combined with drilling and drainage. For the patients who received pressure regulation combined with drilling and drainage, the time from shunt operation to the occurrence of SEHS was 1 month and 21 days, 2 months and 7 days, 4. 5 months, 7. 5 months, and 25. 0 months, respectively. The time from the occurrence of SEHS to the last reexamination with no SEHS detected was 1 month in 7 cases (all were cured by pressure regulation only); >1-3 months in 5 cases (3 cases were treated by pressure regulation combined with drilling and drainage); more than 3 months in 4 cases (2 cases were treated by pressure regulation combined with drilling and drainage). For the patients who received pressure regulation combined with drilling and drainage, the time from the occurrence of SEHS to the last reexamination with no SEHS detected was 1 month and 14 days, 2. 0 months, 3. 0 months, 7. 0 months and 8. 0 months, respectively. Except for 2 cases who experienced pressure regulating valve failure, all other cases were cured. Six cases were unilateral SEHS, and the SEHS volume was about 11 to 75 mL (median;39. 0 mL). Ten cases were bilateral SEHS, and the SEHS volume was about 23-380 mL (median; 158. 2 mL). The 6 cases were all cured by pressure regulation, and 5 cases of them had SEHS at the shunt tube insertion side. Conclusions SEHS in children with hydrocephalus is generally asymptomatic and rarely causes clinical symptoms. SEHS mostly occurs within 6 months after operation, especially within 3 months. SEHS found in 1 month after surgery can be cured by increasing the shunt valve pressure only. Therefore, SEHS can be cured by pressure regulation only by shortening follow - up and identifying SEHS early after shunt operation. This will also reduce the probability that patients require the drilling and drainage operation. © 2022 ＣｈｉｎＪＡｐｐｌＣｌｉｎＰｅｄｉａｔ. All rights reserved.     

儿童溃疡性结肠炎的内镜检查和临床研究

目的 分析儿童溃疡性结肠炎的临床特征及其诊断。方法 对４０例儿童ＵＣ的内镜表现、组织学特点以及临床特征进行分析。结果 儿童ＵＣ占结肠镜检查总数的４％,２个月－１２岁,最小发病年龄生后７ｄ,中度＋重度占７５％（１８＋１２／４０）,临床表现慢性腹泻６８％（２７／４０）,粘液或粘液血便５３％（２１／４０）,反复便血４８％）１９／４０）,腹痛呕吐等不明显,营养不良有３０％（１２／４０）,贫血２８％（１１＝     

儿童颈部占位性病变的影像学分析

目的探讨儿童颈部占位性病变的影像学特征及鉴别诊断。方法回顾性分析本院73例经手术及病理检查证实的颈部占位性病变患儿影像学资料。CT扫描采用西门子128层Blance螺旋CT机,GESignaOvationEXCITE0．35T开放式永磁型磁共振成像仪。结果73例患儿中,先天性病变39例,罕见病种为异位胶质结节、异位甲状腺、异位胸腺;肿瘤病变16例,少见病种为神经母细胞瘤、副神经节瘤;感染性病变18例。结论儿童颈部占位性病变疾病谱与成人明显不同,结合胚胎、解剖、临床及影像学表现分析,可以明显提高诊断准确率。     

幼儿手掌切割伤的特点与治疗

目的 分析儿童手掌切割伤的特点及相应处理方法。方法 5例手掌切断伤患儿,分别有食、中、环指屈肌腱断裂,多合并正中神经损伤。2例急诊病例I修复所有损伤组织,3例晚期病例修复神经和／或屈指肌腱。结果 4例随访2个月－3年,手指保护性感觉均恢复,总主动活动度（TAM）平均达90．0％,1例拇外展丧失。结论 儿童手掌切割伤致尿指肌腱断裂时,多合并正中神经损伤。急诊处理应力争全部修复损伤组织。Ⅱ期手术宜尽早进行,修复方案依具体情况而定。