长时程持续引流治疗重型颅脑损伤去骨瓣减压术后同侧张力性硬膜下积液的临床疗效

目的探讨长时程持续引流(LCD)治疗重型颅脑损伤(sTBI)患者去骨瓣减压术(DC)后同侧张力性硬膜下积液的临床疗效。方法回顾性分析2014年1月至2019年1月于深圳市第二人民医院神经外科行DC后发生手术侧张力性硬膜下积液的14例sTBI患者占同期收治的sTBI患者的19.7%(14/71)]的临床资料其中2014年1月至2017年8月收治的7例患者采用传统方法治疗(TT组),2017年9月至2019年1月收治的7例患者行LCD治疗(LCD组)比较两组患者术后硬膜下积液的发生时间、治疗效果、并发症等指标,所有患者术后均予临床和影像学随访1年。结果14例sTBI患者发生张力性硬膜下积液的时间为DC治疗后(15.6±7.1)d。LCD组和TT组患者硬膜下积液的消退时间中位数(四分位数间距)]分别为DC治疗后21.0 d(6.0d)和69.0 d(65.3 d),两组间的差异有统计学意义(P=0.002)14例患者的硬膜下积液经治疗消退后均无复发,且无颅内感染发生。9例患者出现脑积水,其中LCD组4例、TT组5例3例患者存在切口愈合不良,其中LCD组1例TT组2例。结论对于DC术后发生同侧张力性硬膜下积液的sTBI患者,LCD为有效的治疗方法,可尽早消除硬膜下积液,减少硬膜下积液引起的切口愈合不良等并发症,加快患者的康复。

The clinical efficacy of long-term continuous drainage in treatment of ipsilateral tension subdural effusion after decompressive craniectomy in patients with severe traumatic brain injury

Objective To investigate the clinical efficacy of long-term continuous drainage(LCD)in treatment of ipsilateral tension subdural effusion(SE)after decompressive craniectomy(DC)in patients with severe traumatic brain injury(sTBI).Methods A retrospective analysis was conducted on the clinical data of 14 patients with sTBI who developed ipsilateral tension SE after DC(accounting for 19.7% of 71 sTBI patients admitted during the same period)and admitted to Department of Neurosurgery,Shenzhen Second Peopled Hospital from January 2014 to January 2019.Among them,7 patients admitted from January 2014 to August 2017 were treated with traditional methods(IT group),and 7 patients admitted from September 2017 to January 2019 were treated with LCD(LCD group).Time of SE onset post operation,treatment effects,postoperative complications were compared between the two groups.All patients were followed up for 1 year.Results Fourteen sTBI patients developed tension SE at a mean time of 15.6±7.1 days after DC.The median time of disappearance of tension SE in LCD group and TT group were 21.0 d(interquartile:6.0 d)and 69.0 d(interquartile:65.3 d)respectively.There was significant difference between Uiose two groups(P=0.002).In 14 patients,tension SE disappeared after treatment.There was no recurrence or intracranial infection.Nine patients developed hydrocephalus after treatment of tension SE and included 5 patients in IT group and 4 patients in LCD group.Poor wound healing was observed in 3 cases including 1 case in LCD group and 2 cases in TT group.Conclusions LCD is an effective Ireatment for sTBI patients Avith ipsilateral tension SE after DC,which can eliminate SE as soon as possible,reduce the conaplications such as poor wound healing,improve the cerebrospinal fluid circulation and thus facilitate the patient's recovery.