双侧瞳孔散大的外伤性脑疝手术疗效分析

目的探讨双侧瞳孔散大的外伤性脑疝的手术效果和影响因素。方法67例双侧瞳孔散大的外伤性脑疝患者按原发损伤类型分组并接受手术治疗，于术后半年进行格拉斯哥预后评分（GOS）。结果全组恢复良好3例，中残10例，重残9例，植物生存10例，死亡35例。其中，硬膜外血肿组预后最好，弥漫性脑肿胀组最差，其差异有统计学意义（P〈0．05）。结论双侧瞳孔散大的外伤性脑疝手术疗效与脑原发损伤类型密切相关，硬膜外血肿所致的晚期脑疝应积极手术治疗，患者预后较佳；急性弥漫性脑肿胀所致晚期脑疝手术意义不大；部分脑挫伤和（或）硬膜下血肿导致的晚期脑疝患者经手术治疗仍能够挽救生命。另外，快速准确的术前诊断、恰当的术式选择和围手术期处理是救治成功的必要保证。

Clinical study on operative effect of traumatic cerebral herniation with bilateral mydriasis

Objective To explore the surgical effect to traumatic tentorial herniation with bilateral mydriasis. Methods The patients were divided into three groups, ie, epidural hematoma group, acute diffuse brain swelling group and cerebral contusion and/or subdural hematoma group, to perform clinical outcome analysis. Half year after operation, the neurological outcome was scored according to the Glasgow Outcome Scale. Results Of all, there were three cases with good recovery, 10 with moderate disability, nine with severe disability and 10 with vegetative survival but 35 deaths. The outcome was the best in epidural hemotoma group but the poorest in acute diffuse brain swelling group. Conclusions The operative effect of traumatic cerebral herniation with bilateral mydriasis is related with the type of original injury that is important for selection of operation. Patients with cerebral herniation caused by epidural hematoma should receive immediate operation that will induce better outcome. The operation is not vital for those with cerebral herniation caused by acute diffuse brain swelling. Emergent surgery can save lives of some patients with cerebral contusion and/or subdural hematoma. Rapid diagnosis, correct operation and perioperative treatment may ensure the success of surgery.