去骨瓣减压术治疗大面积脑梗死(附30例报道)

目的 探讨去骨瓣减压治疗大面积脑梗死的意义、手术适应证及手术技巧。方法 回顾分析2010年7月～2015年7月江门市中心医院神经外科收治的30例大面积脑梗死行去骨瓣减压术患者的临床资料,总结分析其手术的意义、手术时机及手术操作的体会。结果 25例患者术后存活,5例死亡。去骨瓣减压术后格拉斯哥昏迷评分(GCS)较术前明显改善(t=-5.08,P<0.05)。术前瞳孔散大24例,术后有16例瞳孔缩小(80%)。术后绝大多数病例CT中线移位较术前回复(28/30)。术后3个月时GOS评分4分7例,3分17例,2分1例,1分5例。结论 去骨瓣减压术是大面积脑梗死的有效治疗手段,早期外科干预、术中充分减压可提高大面积脑梗死患者的生存率。

Decompressive craniectomy for massive ischemic stroke(a report of 30 cases)

ObjectiveTo explore the significance, indication and operative skills of decompressive craniectomy in treatment of massive cerebral infarction.Methods The data of 30 patients with massive cerebral infarction who underwent decompressive craniectomy from July 2009 to July 2015 were retrospectively analyzed.Results 25 cases survived after operation,5 died.Most of the patients had significant increase in Glasgow coma scale(GOS)after surgery(t=-5.08,P<0.05).The midline shift in most of the cases alleviated(28/30).Glasgow outcome score(GOS)at the three-month follow-up after surgery were 4 points in 7 cases,3 points in 17 cases,2 points in 1 cases,and 1 points in 5 cases.Conclusion Decompressive craniectomy was regarded as an effective treatment for the massive cerebral infarction.Surgical intervention in the early stage and thorough decompression contributed to better survival.