创伤性颅内静脉窦损伤急诊手术治疗

目的 探讨创伤性颅内静脉窦损伤患者的临床特点及急诊手术方法.方法 回顾性分析2008年1月至2010年12月我院收治的22例颅内静脉窦损伤患者,分析其临床特点并采用明胶海绵直接压迫、直接或筋膜缝合修补、医用耳脑胶粘合、硬膜悬吊加固、静脉窦结扎等方法止血.结果 术中发现上矢状窦损伤12例,横窦损伤6例,窦汇损伤2例,岩上窦损伤1例,乙状窦损伤1例.术中紧急修补静脉窦损伤19例,止血明确;行静脉窦结扎3例,其中2例为前1/3矢状窦,1例为右侧横窦.根据格拉斯哥预后评分,预后良好(GOS 4～5分)17例,预后差(GOS 2 ～3分)4例,死亡(GOS 1分)1例.结论 对于靠近静脉窦处的颅脑损伤,术前做好应对静脉窦损伤的准备,术中尽早控制致命性大出血,根据静脉窦具体的损伤特点采用相应的修补方法,可提高创伤性颅内静脉窦损伤患者的抢救成功率.

The emergency surgical treatment of traumatic intracranial venous sinus injury

Objective To analyze the clinical features and evaluate surgical procedures of traumatic intracranial venous sinus injury. Methods From January 2008 to December 2010, we analyzed the clinical characteristics of 22 venous sinus injury patients. They were compressed with gelatine spongedirectly, and sutured, and ligated sinus, with the aid of EC glue and suspended the dura to terminate the bleeding. Results We found 12 cases of superior sagittal sinus injury, 6 cases of transverse sinus injury, 2 cases of sinus exchange injury, 1 case of rock sinus injury, 1 case of sigmoid sinus injury. 19 cases needed repair sinus, and 3 cases needed sinus l igation. According to Glasgow Outcome Scale, 17 cases had good prognosis（GOS 4-5）, 4 cases poor（GOS 2-3）, 1 death（GOS 1）. Conclusion We should use the appro- priate surgical approach dealing with different types of intracranial venous sinus injury, which can achieve satisfactory therapeutic effect.