急性颅内血肿清除术后非手术部位迟发性血肿

颅脑外伤颅内血肿急诊开颅血肿清除减压后出现非手术部位迟发性血肿在临床上并不少见。本院自1995年1月至2002年12月共发生此类迟发性血肿28例,占全部外伤手术的8.8%,本文就此类迟发性血肿的发生原因探讨如下。1临床资料1.1一般资料:本组28例,男22例,女6例;年龄17～73岁,平均46.4岁,其中60岁以上8例。致伤原因:交通事故16例,跌伤4例,从高处坠落致伤8例。1.2入院时情况:昏迷18例,未昏迷(包括清醒、嗜睡、模糊)共10例。瞳孔等大光反射灵敏10例;瞳孔等大一侧光反射迟钝6例;瞳孔不等大一侧或两侧光反射消失或迟钝12例。GCS记分:3～5分8例,6～8…     

急性颅内血肿清除后继发对侧迟发性血肿的诊治

一侧颅内血肿清除术后继发对侧血肿可以发生在术中或术后短期内，如得不到及时诊治，致残率和死亡率较高。本院自2000年8月至2005年8月共收治16例，现报道如下。     

急性颅内血肿清除后继发对侧迟发性血肿

目的 探讨急性外伤性颅内血肿清除的术中及术后，及时发现对侧迟发性血肿并治疗的意义。方法 在术中发生急性脑肿胀时应在对侧钻颅探查或术后病人恶化时行CT检查。结果 治疗15例对侧迟发血肿病人其中2例死亡，手术死亡率为6％。结论 在清除急性外伤性颅内血肿时发生急性脑肿胀，或术后病情恶化，应想到对侧可能是迟发性血肿形成，宜尽早复查CT及钻颅探查，早诊早治可改善预后。     

外伤性颅内血肿术后继发迟发性血肿

急性颅内血肿术后继发迟发性血肿，可发生于术中或术后短期内，也是术中急性脑膨出的主要原因之一，处理较为棘手。本院自１９９６年１月至２００１年１月间诊治外伤性颅内血肿术后继发迟发性血肿２１例。现就其诊治体会报告如下。资料与方法本组男１６例，女５例；年龄１８～７１岁，平均４６岁。致伤原因：交通事故伤１５例，坠落跌伤５例，打击伤１例。入院时GCS评分≤８分１３例，９～１２分５例，１３～１５分３例。手术血肿类型：急性硬膜外血肿９例，急性硬膜下血肿７例，脑内血肿合并硬膜下血肿５例。合并其他颅脑损伤情况，脑挫…     

急性幕上血肿术后迟发性后颅窝血肿的临床分析

颅脑外伤后幕上血肿急诊开颅血肿清除术后出现迟发性后颅窝血肿．在临床上并不多见。本院自1999年1月至2004年12月，共收治此类迟发性后颅窝血肿12例，占全部颅脑外伤手术的2．0％。本文就此类迟发性后颅窝血肿的临床特点、发生机制及诊治要点探讨如下．     

外伤性迟发性大脑半球间硬膜下血肿8例

外伤性迟发性大脑半球间硬膜下血肿临床少见，我院神经外科自1994年8月～2005年2月共收治迟发性外伤性大脑半球间硬膜下血肿（delayed traumatic intermispheric subdural hematomas,DTISH）8例，现总结报道如下。     

急性颅内血肿术后非手术部位迟发性血肿

<正>神经外科医生对于外伤性迟发性颅内血肿都很重视,然而颅内血肿术后继发非手术部位迟发血肿也很多,而且本病的预后很差,致残率、致死率很高,引起纠纷的可能也很大,所以必须提高对本病的认识。本院自2006年1月至2009年1月共收治35例,现报道如下。     

额颞部开颅术后硬膜下积液诊治分析

目的探讨额颞部开颅术后硬膜下积液的预防和诊治。方法以非手术为主，包括单纯减压窗加压包扎、积液穿刺并加压包扎，并腰穿放脑脊液，少用或不用脱水剂及改善脑部微循环、神经营养治疗；手术治疗包括：颅骨钻孔引流术、积液腔-腹腔分流术。共治疗额颡部开颅术后出现硬膜下积液患者共31例。结果31例中，行颅骨钻孔硬膜下积液引流术者3例，17例行减压窗弹力绷带加压包扎，11例于减压窗皮瓣下穿刺抽液并弹力绷带加压包扎，弹力绷带包扎者行腰穿放脑脊液。1～2周后复查头颅CT，积液消失者24例，5例积液明显消退，2例头颅CT监测积液有逐渐增多。积液增多者2例行积液腔-腹腔分流术，术后复查头颅CT积液量明显减少。结论额颗部开颅术后硬膜下积液，以预防为先，严格把握去骨瓣减压手术适应证，术中注意冲洗硬膜下血肿及使蛛网膜下腔出血尽量排出，术后注意脱水剂使用的量及时间，及早发现并采取治疗措施。治疗关键在于早期诊断、早期治疗，通过动态头颅CT检查，适当选择治疗方法，并严格掌握手术指征，从而降低术后硬膜下积液发生率及对患者的继发性损伤。     

后颅窝急性硬膜下血肿的诊治

闭合性外伤性后颅窝急性硬膜下血肿较为少见。由于后颅窝容量小，即便是薄层急性硬膜下血肿，也极易引起脑脊液循环受阻，使颅内压急骤升高，加之重要生命中枢位于其间，故病情较为险恶，死亡率较高。本院１９９６年１月至１９９９年１月，共收治急性后颅窝硬膜下血肿５例，占同期外伤性颅内血肿的２．１％，而单纯闭合性外伤性后颅窝急性硬膜下血肿仅２例，均经CT或MRI证实，现报道如下。临床资料１．一般资料：男４例，女１例；年龄１７～５６岁，平均３７．４岁。坠落伤１例，余４例均为车祸伤。５例均是枕部直接受力。急性硬膜下血肿…     

外伤性迟发性颅内血肿的诊治

近年来，CT检查的普及，使得外伤性迟发性颅内血肿早期诊断率和抢救成功率明显提高犤１犦。本院自１９９３年６月至２００１年７月，共收治外伤性迟发性颅内血肿２８例。本文就其临床特点及发生相关因素和诊治，进行探讨。临床资料１．一般资料：本组２８例，男２１例，女７例；年龄２８～８２岁，平均５７．２岁。受伤机制及血肿类型：减速性损伤致外伤性迟发性颅内血肿１９例，其中脑内血肿１２例，硬脑膜下血肿７例。加速性损伤致外伤性迟发性颅内血肿９例，其中硬脑膜外血肿７例，硬脑膜下血肿１例，脑内血肿１例。症状和体征：入院时…     

胰十二指肠切除术后晚期出血的诊断与治疗

目的总结胰十二指肠切除术后晚期出血的诊断与治疗经验。方法回顾性分析2002年1月至2013年2月新疆医科大学第一附属医院收治的246例行胰十二指肠切除术患者的临床资料。胰头及壶腹部恶性肿瘤行标准胰十二指肠切除术或联合脏器切除,良性肿瘤及十二指肠乳头肿瘤行保留幽门的胰十二指肠切除术。消化道吻合采用胰肠或胰胃吻合两种方式。患者术后出血时间〉5d定义为晚期出血。消化道出血为消化道出血组,腹腔出血为腹腔出血组。按出血程度分为轻度和重度出血。采取保守治疗和手术治疗（包括介入和开腹手术治疗）两种方法治疗晚期出血。计数资料组间比较采用Fisher确切概率法。结果246例患者中行标准胰十二指肠切除术224例,行保留幽门的胰十二指肠切除术10例,行胰十二指肠切除联合门静脉切除或置换术9例,行胰十二指肠切除联合肠系膜上静脉置换术1例,行胰十二指肠切除联合肝方叶切除术1例,行胰十二指肠切除联合左半肝切除术1例。246例患者中行改良胰肠端侧吻合127例,行胰胃套入吻合53例,行传统胰肠端端套人吻合39例,行胰管空肠黏膜对黏膜吻合27例。患者围手术期死亡15例,病死率为6．10％（15／246）。术后29例患者发生晚期出血,出血发生率为11．79％（29／246）。其中消化道出血14例,腹腔出血15例。29例出血患者中轻度出血9例（消化道出血5例、腹腔出血4例）;重度出血20例（消化道出血9例、腹腔出血11例）。17例患者术后发生先兆出血,其中消化道出血5例、腹腔出血12例。29例患者均经常规保守治疗,消化道出血组患者保守治疗成功率为8／14,腹腔出血组为2／15,两组比较,差异有统计学意义（P〈0．05）。保守治疗失败患者均中转手术治疗。20例重度出血患者中行手术治疗19例,1例经保守治疗成功。9例轻度出血患者全部行保守治疗,1例因肺部感染死亡,其余均获治愈。29例术后晚期出血患者中死亡10例,病死率为34．5％（10／29）。消化道出血组患者病死率为2／14,腹腔出血组为8／15,两组比较,差异无统计学意义（P〉0．05）。结论胰十二指肠切除术后晚期出血常有先兆出血征象,出血程度多为重度。消化道出血经保守治疗多可治愈,腹腔出血需积极手术治疗。     

Iatrogenic acute subdural hematoma due to drainage catheter

BACKGROUND

Insertion of a catheter for drainage of a cavity is a routine step in many surgical practices. In neurosurgery, catheters are commonly placed in the subdural, subgaleal, or epidural spaces to prevent haematoma formation.

CASE DESCRIPTION

We present three cases of iatrogenic acute subdural hematoma. These were all related to the drainage catheters. In the first case, a subgaleal redivac suction catheter was used after craniotomy for brain abscess. The other two patients had ordinary ventricular catheters placed in the subdural space after burr hole drainage of chronic subdural hematoma. The drainage catheter was removed on postoperative day 5 in the first case and two days after the initial operation in the other two cases. Shortly after the removal of the drains, the conditions of the patients deteriorated rapidly due to the development of acute subdural hematoma.

CONCLUSION

Although they are extremely uncommon, life-threatening complications related to a drainage catheter are a real possibility. Therefore, the procedure should not be taken lightly.     

胃手术后功能性胃排空障碍的诊断与处理

目的探讨胃手术后功能性胃排空障碍(FDGE)的临床特点和处理方法。方法对1998—2003年224例胃手术的病例资料进行回顾性分析。结果224例患者中有9例(4％)在术后3—10(平均7．2)d时出现FDGE，诊断根据临床表现、胃造影和胃镜检查确定。其中毕Ⅱ式胃肠吻合术患者FDGE的发病率为6．1％，显著高于毕Ⅰ式1．8％。经非手术综合治疗9—56(平均22)d后，8例治愈，1例因并发严重肺部感染死亡死亡。结论FDGE是胃术后的近期并发症，毕Ⅱ式吻合术后易发。通过上消化道造影及胃镜检查一般能明确诊断，确诊后采用非手术综合治疗多可治愈。     

Influence of operative timing on prognosis of patients with acute subdural hematoma

Objective: To study the influence of operative timing on the prognosis of patients with acute subdural hematoma (ASDH) in order to provide theoretical basis for clinical treatment.Methods: The clinical data of 202 patients with ASDH undergoing operations were collected, and the mortalities and functional survival rates were analyzed 2, 4, 6, and 8 hours after injury.Results: No significant difference was found in mortalities and functional survival rates at different operative timings. However, there was a clear trend that the shorter the operative timing was, the lower the mortality and the higher functional survival rate were. In addition, the mean time from injury to operation of non-survivors was significantly longer than that of survivors.Conclusions: Operative timing has potential influences on the prognosis of patients with ASDH. Surgical evacuation of ASDH should be performed as soon as possible once the operation indication emerges.     

Influence of operative timing on prognosis of patients with acute subdural hematoma

Objective: To study the influence of operative timing on the prognosis of patients with acute subdural hematoma (ASDH) in order to provide theoretical basis for clinical treatment.Methods: The clinical data of 202 patients with ASDH undergoing operations were collected, and the mortalities and functional survival rates were analyzed 2, 4, 6, and 8 hours after injury.Results: No significant difference was found in mortalities and functional survival rates at different operative timings. However, there was a clear trend that the shorter the operative timing was, the lower the mortality and the higher functional survival rate were. In addition, the mean time from injury to operation of non-survivors was significantly longer than that of survivors.Conclusions: Operative timing has potential influences on the prognosis of patients with ASDH. Surgical evacuation of ASDH should be performed as soon as possible once the operation indication emerges.     

腹部非胃手术后功能性胃排空障碍的诊治分析

目的:探讨腹部非胃手术后功能性胃排空障碍的病因、发病机制、诊断、治疗和预防方法。方法:回顾性分析我院2011年8月至2012年8月间诊治的8例腹部非胃手术后功能性胃排空障碍病人的临床资料。结果:8例病人平均年龄为(69.9±11.2)岁,均为开腹手术。6例(75.0%)有腹部手术史,5例(62.5%)手术时间超过3 h。术前5例(62.5%)有低蛋白血症,4例(50.0%)有贫血。所有病人均表现为上腹饱胀伴呕吐,胃振水音明显,鼻胃管引流出胃液800~1 500 mL/d。所有病人均经泛影葡胺胃造影确诊。均行保守治疗,7例(87.5%)保守治疗成功,其中5例(71.4%)于2周内治愈。结论:腹部非胃手术后功能性胃排空障碍是多病因疾病。多发生在胆道手术胆漏、复杂腹部手术、长期胃肠吻合输出襻梗阻解除后。消化道造影及胃镜检查是诊断的重要手段。采取保守治疗多可治愈,充分的术前准备和完善的术后处理有助于预防。     

Contralateral development of chronic subdural hematoma after evacuation of chronic subdural hematoma. A case report

Contralateral acute complications such as acute epi/subdural hematomas can be encountered after evacuation of a chronic subdural hematoma, though they are rare. We found only one case of chronic subdural hematoma following the surgery for contralateral chronic subdural hematoma, have been published in English language literature. A 73-year-old male admitted to our hospital with a right-sided subdural hematoma. The subdural hematoma was evacuated through a burr-hole. A left-sided subdural higroma appeared after operation and turned into classical subdural hematoma in the course of time. After evacuation of contralateral chronic subdural hematoma, the patient recovered completely. All stages of the development of contralateral chronic subdural hematomas were shown by serial computed tomograms. It was suggested that traumatic chronic subdural hematomas develop from mostly subdural higromas. If contralateral subdural higroma is seen after surgical evacuation of a chronic subdural hematoma, the possibility of development of contralateral chronic subdural hematoma must be kept on mind.     

Endoscopic removal of organized chronic subdural hematoma

An endoscopic surgical approach to organized chronic subdural hematoma is described. Advantages of the endoscopic approach include access to virtually the entire hematoma cavity through a small craniectomy performed with local-standby anesthesia. Two illustrative cases are presented.