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急性重度颅脑外伤并侧裂区损伤的手术治疗
引用本文:向进,郭伟,陈东,赵永阳.急性重度颅脑外伤并侧裂区损伤的手术治疗[J].广东寄生虫学会年报,2010(8):969-971.
作者姓名:向进  郭伟  陈东  赵永阳
作者单位:暨南大学第二临床医学院深圳市人民医院神经外科,深圳518020
摘    要:目的探讨采用标准外伤大骨瓣开颅血肿清除并侧裂池减压,术中对天幕裂孔疝患者行天幕切开脑疝复位术治疗急性重度颅脑外伤并侧裂区损伤的临床意义。方法 31例急性重度颅脑伤并侧裂区损伤患者(格拉斯哥昏迷评分GCS≤8分),采用标准外伤大骨瓣开颅血肿清除去骨瓣减压后,在显微镜下将侧裂池蛛网膜切开,冲洗引流,敞开侧裂池充分减压,对术前天幕裂孔疝患者行天幕切开并复位。结果 12个月全部病例获得随访,随访MRI+MRV检查:侧裂区水肿消退,侧裂区静脉回流畅顺。术后生存25例,生存率为80.6%,死亡6例,死亡率为19.4%;GOS评分:恢复良好19例,中残3例,重残2例,植物生存1例。结论采用标准外伤大骨瓣开颅血肿清除去大骨瓣减压、侧裂池减压并天幕裂孔疝复位术能提高急性重度颅脑外伤并侧裂区损伤,可提高生存率、降低死残率、提高生存质量,值得临床推广应用。

关 键 词:急性重度颅脑外伤  侧裂区损伤  标准外伤大骨瓣开颅术

The Treatment on Operation of Acute Severe Brain Injury with Lateral Fissure Lesion
XIANG Jin,GUO Wei,CHEN Dong,ZHAO Yong-yang.The Treatment on Operation of Acute Severe Brain Injury with Lateral Fissure Lesion[J].Journal of Tropical Medicine,2010(8):969-971.
Authors:XIANG Jin  GUO Wei  CHEN Dong  ZHAO Yong-yang
Institution:(The Second Affiliated Hospital of Jinan University Medical College,Department of Neurosurgery,Shenzhen People's Hospital,Shenzhen 518020,China)
Abstract:Objective To investigate the clinical significance using standard large trauma craniotomy and lateral cistern hematoma decompression surgery operated on patients with tentorial hernia tentorial incision hernia reduction treatment of acute severe brain injury and lateral fissure damage.Method 31 cases of tentorial hernia tentorial incision hernia reduction treatment of acute severe brain injury and lateral fissure damage(GCS艽8)were treated with standard large trauma craniotomy hematoma clearance craniectomy,Lateral fissure and tentorial hernia pool vacuum reposition.Results All patients were followed up for 12 months and are investigated for MRI +MRV examination:Sylvian area swelling,lateral fissure of venous flow.Postoperative survival in 25 cases,with 80.6% survival rate.6 died,with mortality rate 19.4%.GOS score:19 patients with good recovery,moderate disability in 3 cases,2 cases of severe disability,and Vegetative state in 1.Conclusion Standard large trauma craniotomy hematoma clearance craniectomy,lateral fissure and tentorial hernia pool vacuum reposition can increase the survival rate in acute severe brain injury and lateral fissure damage,reduce mortality and disability rate,improve the quality of life,is worthy of clinical application.
Keywords:acute severe brain injury  lateral fissure lesion  standard large trauma craniotomy
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