儿童急性硬膜外血肿的特点及治疗

本文报告 2 3例儿童急性硬膜外血肿 (ＥＤＨ) ,头颅ＣＴ扫描确诊 2 0例 ,急诊开颅 3例。入院时ＧＣＳ <8分 2例 ,8～ 12分 10例 ,13～ 15分 11例。ＣＴ提示中线结构移位 >1.0ｃｍ者 9例。幕上血肿 2 2例 ,均为一侧单发性血肿 ,后颅凹 1例。脑挫裂伤 6例 ,头痛 10例 ,呕吐 5例 ,短暂意识障碍 15例 ,有明显中间清醒期 3例 ,无明显症状 13例。双侧瞳孔不等大 3例 ,偏瘫 2例。手术治疗 15例 ,保守治疗 8例 ,2例康复出院 ,1例并广泛脑挫伤死于肺部感染。故急性外伤性ＥＤＨ一旦确诊 ,应立即手术 ,但某些ＥＤＨ可采取保守治疗 ,认为必须根据血肿的…     

小儿外伤性硬膜外血肿的特点与治疗(附32例报告)

报告32例小儿外伤性硬膜外血肿的临床特点及治疗结果。幕上血肿19例，手术治疗16例，平均血肿量45ml，保守治疗7例，平均血肿量24．5ml；后颅窝血肿9例，手术治疗5例，平均血肿量22ml，保守治疗4例，平均血肿量8ml；14例（44％）伴有颅骨骨折；2例合并硬膜下血肿，1例合并脑挫裂伤；32例中急性8例（25％），亚急性22例（68．8％），慢性2例（6．2％），经手术或保守治疗全部治愈，死亡率和致残率为0。作者认为认识小儿外伤性硬膜外血肿的特点，正确把握手术和非手术指征，均会得到满意的治疗结果。     

小儿急性血肿型肺吸虫脑病的外科治疗

目的 分析小儿急性血肿型肺吸虫脑病的临床特点和诊治方法,探讨该型与其他类型的区别.方法 回顾性分析16例急性血肿型肺吸虫脑病患儿的临床特点、诊断方法和治疗效果.结果 16例患儿均有高颅压症状,惊厥发作5例,肢体偏瘫或单瘫4例,合并肺部症状4例；流行病学史阳性14例；全部病例肺吸虫抗体检测阳性；CT检查发现单纯脑内血肿12例,伴蛛网膜下腔出血3例,伴脑梗塞1例,血肿以额叶、顶叶为主.手术开颅清除血肿11例,非手术治疗5例,所有病例均口服吡喹酮治疗4～6个疗程,随访2个月至2年,预后良好.结论 小儿急性血肿型肺吸虫脑病与其他类型有较大差别,病程更短、病情更为危重；影像学检查易出现误诊、漏诊；治疗上更倾向于积极手术；规范治疗预后更好.     

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。     

小儿颅脑损伤术中急性脑膨出

我们自 1988～ 1999年共有 16例颅脑损伤患儿术中出现急性脑膨出。现对其发生机制、治疗进行分析和讨论。临床资料一、一般资料　本组男 11例 ,女 5例。年龄 3～ 13ａ ,术前脑疝 5例。受伤原因 :交通事故 5例 ,高处坠落 11例。二、临床表现　入院时ＧＣＳ评分 :3～ 8分 9例 ,9～ 12分7例。ＣＴ示 :硬膜下血肿 4例 ,硬膜下血肿伴脑挫裂伤 5例 ,脑内血肿 3例 ,脑内血肿伴对侧硬膜下血肿、一侧硬膜下血肿及脑挫裂伤伴对侧脑内血肿各 2例 ;全组中线移位 >5ｍｍ者占 70 %。伤后 2ｈ内手术 8例 ,6～ 2 4ｈ内手术 5例 ,2 4ｈ～ 3ｄ内手术 3例。开颅…     

小儿颅脑损伤的临床特点

小儿在代谢、生理等诸方面,具有其不同于成人的许多特点。因此,小儿颅脑损伤从致伤原因、临床表现、预后等均存在其特殊之处。我们收治100例,就其临床特点进行了分析。临床资料一、一般资料：100例中男66例,女34例,年龄7mo～12a。平均6．3a。脑挫裂伤84例,合并急性硬膜外血肿15例;硬膜下血肿23例;脑内血肿5例;小脑血肿并原发脑干损伤1例;颅骨骨折41例,其中12例为凹陷骨折;开放性颅脑损伤8例。脑震荡16例,合并急性硬膜外血肿9例;亚急性硬膜外血肿5例。16例均有骨折,其中3例为凹陷骨折。二、致伤原因及临床表现：坠落伤61例,…     

儿童纵隔神经源性肿瘤单中心外科治疗经验CSCD

目的 分析儿童纵隔神经源性肿瘤行手术治疗患儿的临床特征、治疗方法及预后。方法 收集中国医科大学附属盛京医院小儿外科2012年1月至2021年12月间收治的30例纵隔神经源性肿瘤患儿临床资料,对其临床症状、影像学表现、治疗方法、病理类型及预后资料进行回顾性分析。结果 30例患儿平均年龄4.7岁(1~13岁),男20例,女10例。8例患儿未出现特异性症状(8/30,26.7%),7例为检查过程中意外发现,1例为肾上腺节细胞神经母细胞瘤术后随诊过程中发现;18例患儿因呼吸道症状就诊(18/30,60.0%),表现为咳嗽、咳痰、喘息等;2例胸背痛(2/30,6.7%);2例锁骨上淋巴结肿大(2/30,6.7%);12例伴发热(12/30,40.0%)。行胸腔镜手术16例(53.3%),胸腔镜辅助开胸手术9例(30.0%),开胸手术5例(16.7%)。术后病理检查结果:神经母细胞瘤4例(13.3%),神经节母细胞瘤8例(26.7%),节细胞神经瘤16例(53.3%),神经鞘瘤1例(3.3%),原始神经外胚层肿瘤2例(6.7%)。30例中良性16例(53.3%),恶性14例(46.7%)。结论 小儿纵隔肿瘤症状不典型,难以早期发现,胸部CT及MRI是诊断的主要手段,经手术治疗后预后相对较好。     

婴幼儿及儿童外伤性硬膜外血肿治疗决策

目的 探寻婴幼儿及儿童外伤性硬膜外血肿的最佳治疗方法.方法 对43例婴幼儿及儿童外伤性硬膜外血肿采取保守治疗17例、钻孔引流血肿溶解治疗23例、开颅血肿清除治疗3例,评价疗效.结果 随访1年,格拉斯哥预后评分1分1例,3分2例,4分5例,5分35例.结论 婴幼儿及儿童外伤性硬膜外血肿有手术指征者应尽早手术,手术方式最好选择钻孔引流血肿溶解术,简便易行,是治疗婴幼儿及儿童硬膜外血肿的有效方法之一.     

小儿外伤性十二指肠血肿并肠梗阻13例

目的：探讨腹部闭合性损伤小儿中十二指肠血肿并肠梗阻的诊断策略和治疗原则。方法回顾性分析本院2006年1月至2013年3月收治的13例腹部闭合性损伤致十二指肠血肿并肠梗阻患儿的临床资料。年龄4～12岁,其中男性9例,女性4例。血肿长径6．0～11．0cm,其中8例术前已明确诊断,5例经术中探查确诊。手术时受伤时间2～6d。患儿均行剖腹探查加十二指肠浆膜下及腹膜后血肿清除术,术后均留置引流管。其中3例同时行近端空肠造瘘术。术后定期复查。结果13例均顺利完成手术。术后2例出现伤口感染,无其他严重并发症,均顺利恢复。经半年以上复查随访未见异常。结论详细的病史采集结合X线、B超和CT等辅助检查对于小儿腹部闭合性损伤致十二指肠血肿并肠梗阻的早期诊断至关重要。积极手术探查有利于明确诊断并给予及时处理,术后严重并发症少,治疗效果满意。     

小儿外伤性脑血管痉挛和梗塞的临床诊治

目的 探讨小儿外伤性脑血管痉挛和梗塞的诊断及治疗。方法 回顾性分析1992～2004年收治的外伤性偏瘫患儿82例。结果 全部行头颅CT检查，65例发现无颅内血肿，22例头颅基底节区或侧脑室旁有低密度区病灶，43例头颅CT无异常，均采用内科保守综合治疗，恢复良好。结论 外伤性脑血管痉挛和梗塞不需外科干预，采用内科综合治疗，可得到较好预后。     

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。     

Coexistence of rapidly resolving acute subdural hematoma and delayed traumatic intracerebral hemorrhage

Rapid resolution of acute subdural hematoma is rare. Delayed traumatic intracerebral hematomas following medical or surgical treatment of increased intracranial pressure have also been reported. Coexistence of a quickly resolving acute subdural hematoma and a delayed traumatic intracerebral hemorrhage has not been reported before. A 13-month-old boy was admitted to our emergency department after a car accident. On CT, a thin acute subdural hematoma on the right frontotemporal region and a small epidural hematoma on the left frontal region could be seen. On 24-hour follow-up CT, the right subdural hematoma was found to be less dense but larger than it had been before. At 36 h after hospitalization, CT showed that the right acute subdural hematoma had completely disappeared; however, a delayed traumatic intracerebral hematoma on the left occipital region was identified. We think that the mechanism involved in the development of a delayed intracerebral hematoma in our case was similar to the one causing delayed traumatic intracerebral hematoma after treatment for increased intracranial pressure.     

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。     

儿童外伤性硬膜下血肿临床特点

目的 探讨儿童外伤性硬脑膜下血肿的临床特点.方法 回顾性分析了6年间收治的儿童硬脑膜下血肿166例的临床特点.结果 儿童硬脑膜下血肿占同期儿童颅脑外伤的15.1%、颅内血肿的31.6%.新生儿、婴幼儿在本组中占42.2%.随着年龄的增长,造成出血的主要原因依次为产伤、坠落伤以及车祸和暴力伤害.血肿主要位于小脑幕上,主要症状为:头痛、呕吐、意识障碍、癫痫和神经系统局灶症状.需要手术治疗者仅为所收治患儿的24.7%,手术方法包括钻孔血肿引流术和开颅血肿清除术.结论 儿童硬膜下血肿多数可以保守治疗,手术治疗的指征是:有意识障碍及神经功能缺陷,CT显示血肿较大,占位效应明显.多数经及时治疗后预后较好.     

Retroclival epidural hematoma in a child affected by whiplash cervical injury: a typical case of a rare condition

Traumatic posterior fossa epidural hematomas are uncommon lesions. Among these lesions, retroclival epidural hematomas (REDH) are particularly rare conditions that usually occur in the pediatric population due to predisposing anatomical features in this patient group. We describe a typical case of traumatic REDH from the mechanism of trauma to outcome. This 8-year-old girl was involved in a motor vehicle accident leading to whiplash cervical injury and cranial nerve palsy. Any children involved in a severe motor vehicle accident with such a sequence of events should raise suspicion for prompt diagnosis.     

婴幼儿急性颅脑损伤临床分析

目的 探讨3岁以下婴幼儿急性颅脑损伤的特点.方法 回顾性分析49例3岁以下婴幼儿急性颅脑损伤资料,临床主要表现为:抽搐、呕吐、前囱门隆起紧张,意识障碍,局灶性神经系统体征,贫血及呼吸紊乱窘迫.分为三组:轻度颅脑损伤(19例),中度颅脑损伤(22例),重度颅脑损伤(8例),头颅CT显示:①均有颅内出血,包括急性、亚急性硬膜下血肿(SDH)和蛛网膜下腔出血(SAH),最常见出血部位为大脑镰,小脑幕及大脑凸面;②伴局灶性或弥漫性(大面积)脑实质低密度.多发生在6个月以下的婴幼儿,伴大面积低密度灶患儿多预后不良.结果按GOS预后评级,良好39例,中残6例,重残2例,死亡2例.结论 婴幼儿生理特点有其特殊性,依据婴幼儿急性颅脑损伤的特点,早期采取积极有效的治疗措施,可降低病死率及致残率,婴幼儿神经系统修复能力强,与成人相比多预后良好.     

Transient Anton's syndrome: a presenting feature of acute epidural hematoma at the confluens sinuum

Although unilateral epidural hematomas are well known, bilateral presentation, especially at the confluens sinuum, is uncommon, and its diagnosis may be delayed, thus causing morbidity. We report a case of acute posttraumatic cortical blindness due to epidural hematoma at the confluens sinuum caused by venous sinus tearing. The epidural hematoma was evacuated and the dural tear was repaired. The patient remained alert throughout the hospitalization. Examination of the visual field revealed recovery postoperatively, and the patient was discharged. We discuss the pathological mechanisms of transient blindness. The importance of anopsia as an early sign of epidural hematoma is emphasized.     

Prognostic factors in cerebral hypoxic-ischemias in infants less than a year old

In order to establish criteria for early cerebral prognosis after acute cerebral hypoxic ischemic insult, we studied 31 cases of patients presenting, during their first year of life, cardio-respiratory arrests due to SIDS (21 cases), anesthesia (4 cases), other causes (6 cases). A favourable evolution was observed in 5 cases where coma lasted less than 8 hours. Conversely unfavorable evolution was seen in the 26 patients (21 deaths, 5 sequellae) where coma lasted more than 8 hours. Among 12 patients of this group surviving after the 4th day, 9 expressed seizures or status epilepticus. The poor evolution was correlated with hyperproteinorachia during the first 24 hours and with cortico-subcortical hypodensity on CT scan. Early EEG and transfontanellar echography seemed less useful to establish a prognosis, specifically to discriminate children surviving with and without sequelae.     

Symptomatic calcified subdural hematomas

Two unique cases of chronic calcified subdural hematomas are reported in children as a long-term complication of a ventriculoperitoneal shunt. Both the patients had undergone shunt procedures in infancy for congenital hydrocephalus. In one patient, the cause of the hydrocephalus was aqueduct stenosis, while in the second patient, a lumbar meningomyelocele was associated with hydrocephalus. In both these patients, a ventriculoperitoneal shunt was done in infancy. In one of them, following the shunt surgery, a bilateral subdural collection was noticed which required burr hole evacuation. Both the patients remained asymptomatic for 9 years, when they presented to our center with acute raised intracranial pressure and contralateral hemiparesis. Both the patients had a relatively short history and had altered sensorium at admission. Surprisingly, in both the patients, the CT scan showed significant mass effect producing calcified subdural hematomas. The shunt systems were found to be working well at surgery. Craniotomy and excision of the calcified subdural hematomas was undertaken. Postoperatively, the patients showed satisfactory recovery, and at discharge the patients were doing well. At the follow-up at the outpatient clinic, the patients were asymptomatic.     

儿童创伤性主支气管断裂的诊断与治疗

目的：探讨儿童创伤性主支气管断裂的诊断和治疗特点,提高治愈率。方法：对８例儿童创伤性主支气管断裂的诊断和外科治疗及预后进行观察。结果：６例早期诊断急诊剖胸探查行主支气管一期吻合术,痊愈出院,无并发症。２例延误诊断,其中１例伤后３月手术行主支气管对端吻合术,术后出现肺部感染和吻合口狭窄,经多次激光切除肉芽组织,解除吻合口狭窄,恢复正常肺功能,１例伤后６月,因胸腔感染,全肺不张,试吻合支气管后肺不膨胀而被迫行右全肺切除。本组８例随访１～１０年,无死亡,７例支气管吻合术均恢复正常肺功能,１例右全肺切除者,肺功能轻到中度障碍。结论：早期诊断和手术是提高儿童创伤性主支气管断裂的疗效,减少并发症的唯一有效措施。