外伤性后颅窝血肿的诊治体会(附26例报告)

目的探讨外伤性后颅窝血肿的诊断和治疗。方法对26例外伤性后颅窝血肿根据血肿量和GCS评分情况选择手术或保守治疗。结果本组11例血肿量<10 ml,GCS评分>12分,无脑室、脑干受压移位(环池清晰),在严密观察、对症治疗及颅内压监测、CT动态监控下行保守治疗。15例血肿量>10ml,出现意识状态突然变化,烦燥、剧烈头痛、频繁呕吐,而且靠近枕骨大孔区,积极手术治疗。预后18例恢复良好,3例重残,死亡5例。保守治疗无一例死亡。结论外伤性后颅窝血肿缺乏特有的临床征象,但可以形成枕骨大孔疝而导致死亡。早期诊断比较困难,主要依靠头颅CT或MRI检查。根据出血量和GCS评分而选择手术或保守治疗。

Realize for the diagnosis and treatment of traumatic hematoma of the posterior fossa (a report of 26 cases)

Objective To study the diagnosis and treatment of traumatic hematoma in the posterior fossa. Methods The surgical operation and conservative treatment was determined by GCS index and the amount of hematoma in 26 cases. Of them, 11 cases with the amount of hematoma less than 10ml, GCS index larger than 12, without ventricle and brain stem movement under pressure (clear ambient cistern), were in the non-surgical group receiving conservative treatment by careful observation, dynamic monitoring of encephalic pressure under CT. 15 cases with the amount of hematoma more than 10ml, with abrupt changes of consciousness, fidgety, severe headache, frequent vomit, and hematoma close to transforamen mangna, were in the surgical group. Results Of all 26 cases, 18 were well recovered, 3 were deformed and 5 dead. In the non-surgical group, no patients died. Conclusions Traumatic hematoma in the posterior fossa, which may cause deadly transforamen mangna herniation, lacks the specific characters clinically. Its early diagnosis mainly depends on CT or MR. The amount of hematoma and GCS index is the key in deciding whether to choose surgical or conservative treatments.