创伤性急性硬膜下血肿术后并发对侧硬膜外血肿的诊疗

目的：分析颅脑创伤性急性硬膜下血肿患者开颅减压术后并发对侧硬膜外血肿的临床、生化、影像学资料。探讨其形成机制，总结其临床诊断及治疗要点。方法：对27例颅脑创伤性急性硬膜下血肿病例行开颅血肿清除减压术，术后并发对侧硬膜外血肿进行再次手术，对所有病例的临床、生化、影像资料以及治疗、预后进行回顾性分析。结果：27例患者术前均有D二聚体水平异常增高出现，术后4例死亡，余23例病人随访6个月行COS评分，恢复良好及轻度残疾者11例，重残及植物生存者12例。结论：该类病例颅脑损伤重、手术减压迅速解除损伤血管受压、纤溶功能亢进等可能是其发生的主要机制。术前、术中、术后密切观察病情变化及动态CT检查是及早发现并处理这种比较少见的对侧硬膜外血肿的主要手段。

Diagnosis and treatment of contra-lateral epidural haematoma after evacuation of the traumatic acute subdural hematoma

Objective： To analyze the clinical, biochemical and radiological data of the patients with contra-lateral epidural haematoma after the evacuation of opposite side acute subdural haematoma from craniocerebral trauma, discuss its forming mechanism, and summarize the main points of its clinical diagnosis and treatment. Methods：27 patients with acute traumatic subdural hematoma were administered between Jan.,2003 and Jan.,2008. All of them were treated with the operation of subdural hematoma evaeuation and decompression, and after that they suffered contra-lateral epidural haematoma and then were operated again. Clinical, biochemical and radiological data together with its treatment and prognosis were analyzed retrospectively. Results： D-dimer levels in all 27 cases of patients were abnormally high before operation, 4 died after the second surgical treatment, and the remained 23 underwent 6 months follow-up visit and were evaluated by GOS grading. 11 cases were Good and Moderately Disabled, and 12 cases were with fibrinolysis hyperfunction, the surgery reduces intracranial pressure and then relieves the press that compresses the injuried blood vessel on the opposite side. In summary close observation and dynamic CT scans in pre-operation, in-operation and post-operation are critical for early diagnosis and treatment of this rare contra-lateral epidural haematoma.