对冲性颅脑损伤双侧血肿的手术策略

【摘要】〓目的〓探讨对冲性颅脑损伤所导致的颅内双侧血肿的手术策略,以提高此类患者的预后。方法〓回顾分析我院颅脑创伤中心2011年10月至2014年10月由同一术者手术治疗的97例对冲性颅脑损伤患者的病例资料,根据术前头CT所示,将患者分为三型,Ⅰ型:着力侧硬膜外血肿为主(20例),Ⅱ型:着力侧硬膜外血肿量与对冲侧血肿量(硬膜下血肿或者脑挫裂伤伴实质内血肿)相当(29例),Ⅲ型:对冲侧血肿(硬膜下血肿或者脑挫裂伤伴实质内血肿)为主(48例)。对上述三型患者采取针对性的手术治疗。结果〓Ⅰ型患者主要先行着力侧的硬膜外血肿手术处理,对冲侧根据术前(达到手术指征同期手术)及术后(复查CT,血肿增多达到手术指征即手术,未增多则行颅压监护)情况决定是否手术;Ⅱ型患者术前双侧血肿未达手术指征根据GCS评分及瞳孔决定是否手术,达到手术指征则行同期双侧血肿清除;Ⅲ型患者先行着力侧钻孔引流,再行对冲侧血肿清除,术中使用超声检查着力侧血肿决定进一步治疗。根据GOS评分判断患者预后,其中预后良好45例,轻度残疾22例,重度残疾11例,植物生存11例,死亡8例。结论〓对冲性颅脑损伤双侧血肿患者根据术前头CT血肿分型采取针对性的手术策略,可以取得较好的预后。

Operation strategy for bilateral hematomas caused by contrecoup craniocerebral injury

【Abstract】〓Objective〓To explore the operation strategy for bilateral intracranial hematoma caused by countercoup craniocerebral injury,in order to improve the prognosis of such patients. Methods〓Clinical data of 97 patients with contrecoup craniocerebral injury operated by the same surgeon in our craniocerebral trauma center from Oct 2011 to Oct 2014 were retrospectively analyzed, the patients were divided into three types according to the CT preoperatively,type I:epidural hematoma was mainly in the injured side (20 cases), type Ⅱ: the volume of epidural hematoma in the injured side was as much as in the contralateral side(subdural hematoma or contusion and laceration of brain with hematoma) in 29 cases, type Ⅲ: hematoma was mainly in the contralateral side(subdural hematoma or contusion and laceration of brain with hematoma)(48 cases). Corresponding operation strategies in the three types patients were taken. Results〓Epidural hematoma in the injured side of type I patients should be taken operation treatment firstly, in the contralateral side, whether to take operation depends on the conditions of preoperative (to take operation with the indication of surgery) and postoperative (review of CT, if hematoma increases to the surgical indication, evacuating hematoma; if not, taking intracranial pressure monitoring); according to GCS score and pupil of type Ⅱ patients without the indication of surgery to decided whether to take operation, if reached, evacuating bilateral hematomas; for type Ⅲ patients, at first drilling drainage in the injured side, reclearing contralateral hematoma, using intraoperative ultrasonography to detect the hematoma of the injured side with the demand of the further treatment or not. According to GOS score to judge the prognosis of patients with good prognosis, of which 45 cases, mild disability in 22 cases, severe disability in 11 cases, plant survival of 11 cases, 8 cases of death. Conclusion〓Patients with bilateral intracranial hematoma caused by contrecoup craniocerebral injury should be treated with corresponding operation strategy according to the CT preoperatively: They can achieve good prognosis.