标准大骨瓣减压加坏死脑组织清除治疗外伤后恶性脑肿胀疗效观察

目的 探讨标准大骨瓣减压加坏死脑组织清除治疗外伤后恶性脑肿胀的疗效.方法 80例伴发外伤后恶性脑肿胀的重型颅脑损伤患者,40例行标准大骨瓣开颅减压手术治疗,40例行标准大骨瓣开颅减压加坏死脑组织清除手术治疗,术后15 d及术后6个月观察治疗效果,对结果 进行比较分析.结果 标准大骨瓣减压加坏死脑组织清除手术治疗组患者术后15 d内颅高压发生率37.5%(15/40)、脑组织切口疝发生率32.5%(13/40),均明显低于单纯标准大骨瓣减压手术治疗组,分别为15.0%(6/40)和10.0%(4/40),P<0.05,伤后6个月患者优良(良好+中残)率(60.0%)显著高于单纯标准大骨瓣减压手术治疗组(40.0%),P<0.05.结论 采用标准大骨瓣减压加坏死脑组织清除手术可有效降低外伤后恶性脑肿胀患者的颅高压,降低重型颅脑损伤患者病死率和致残率,提高治疗效果.

Standard decompressive craniectomy with large bone flap resection and removal of necrotic brain tissues for malignant brain swelling after brain injury

Objective To observe the curative effects of malignant brain swelling after brain injury by using the operations of standard large Craniotomy decompression and removal of necrotic brain tissues. Methods 80 cases of malignant brain swelling after severe brain injury were observed. The standard decompression surgery of large era-niotomy routine were used in 40 cases,while the operations of standard large craniotomy decompression and removal of necrotic brain tissues were used in the other 40 cases. The curative effects of the results after 15 days and six mon-ths were analyzed. Results The incidence of intracranial hypertension (37.5%, 15/40 ) and brain tissue incisional hernia (32.5% ,13/40)of the group using standard large craniotomy decompression and removal of nee-rotic brain tissues treatment was significantly lower than that of simple standard large craniotomy decompression treat-ment group 15.0% (6/40) vs 10.0% (4/40)] after 15 days (P<0.05 ). The prognosis excellent rate ( good + re-sidual) of the group using standard large Craniotomy decompression and removal of necrotic brain tissues treatment was significantly higher (60.0%) than that of simple standard large craniotomy decompression treatment group (40.0%) after six months (P<0.05 ). Conclusion The operations of standard large craniotomy decompression and removal of necrotic brain tissues can effectively reduce the intracranial hypertension of malignant brain swelling after trauma injury,and reduce mortality and morbidity of severe brain injury.