CAJ | 학술논문

目的阐述双侧脑挫裂伤的手术治疗策略并评价其临床意义.方法根据临床表现、CT检查及颅内压(ICP)数值对25例双侧脑挫裂伤实施不同的手术治疗策略,按照控制颅高压和脑保护原则将手术方式分为6类,术后进入神经外科重症监护病房规范治疗.统计分析手术并发症及伤后6个月的格拉斯哥预后(GOS)评分.结果第1类:单侧去骨瓣减压并挫裂伤切除4例;第2类:单侧去骨瓣减压并双侧挫裂伤切除8例;第3类:双侧去骨瓣减压并单侧挫裂伤切除5例;第4类:双侧去骨瓣减压5例;第5类:双侧挫裂伤切除1例;第6类:双侧去骨瓣减压并挫裂伤切除2例.术后癫痫、挫裂伤灶扩大、脑梗死、脑膨出、脑脊液切口漏、颅内感染、硬膜下积液、脑积水等并发症发生率低.伤后6个月GOS:恢复良好6例,中残8例,重残3例,植物生存5例,死亡3例.结论双侧脑挫裂伤可以采用不同手术治疗策略,根据临床表现、CT、颅内压值,以降低颅内压、防止继发性损伤和保护脑功能来制定手术策略,能提高治疗效果.
목적 천술쌍측뇌좌렬상적수술치료책략병평개기림상의의.방법 근거림상표현、CT검사급로내압(ICP)수치대25례쌍측뇌좌렬상실시불동적수술치료책략,안조공제로고압화뇌보호원칙장수술방식분위6류,술후진입신경외과중증감호병방규범치료.통계분석수술병발증급상후6개월적격랍사가예후(GOS)평분.결과 제1류:단측거골판감압병좌렬상절제4례;제2류:단측거골판감압병쌍측좌렬상절제8례;제3류:쌍측거골판감압병단측좌렬상절제5례;제4류:쌍측거골판감압5례;제5류:쌍측좌렬상절제1례;제6류:쌍측거골판감압병좌렬상절제2례.술후전간、좌렬상조확대、뇌경사、뇌팽출、뇌척액절구루、로내감염、경막하적액、뇌적수등병발증발생솔저.상후6개월GOS:회복량호6례,중잔8례,중잔3례,식물생존5례,사망3례.결론 쌍측뇌좌렬상가이채용불동수술치료책략,근거림상표현、CT、로내압치,이강저로내압、방지계발성손상화보호뇌공능래제정수술책략,능제고치료효과.
Objective To explore the operative strategies for bilateral brain contusion and laceration and evaluate their clinical significance.Methods Based on the clinical manifestations,computed tomography (CT) and intracranial pressure (ICP),different operative strategies were applied to 25 cases of bilateral brain contusion and laceration.The strategies were classified into 6 types according to the principles of decompression and brain protection.All cases received routine treatments at neurosurgical intensive care unit (ICU) ward.And the occurrences of operative complications and 6-month Glasgow outcome scale (GOS) were statistically analyzed.Results Type 1 ∶4 cases of unilateral decompressive craniectomy without resection of contusion focus; Type 2∶8 cases of unilateral decompressive craniectomy with resection of bilateral contusion focus ; Type 3∶5 cases of bilateral decompressive craniectomy with resection of unilateral brain contusion ; Type 4 ∶ 5 cases of bilateral decompressive craniectomy ; Type 5 ∶ 1 case of bilateral brain contusion resection; Type 6∶2 cases of bilateral decompressive craniectomy and brain contusion resection.Postoperative complications such as epilepsy,expanding contusion foci,brain infarction,encephalocele,incisional CSF leakage,intracranial infection,subdural hydroma and hydrocephalus were rare.The 6-month GOS revealed 6 cases of good outcome (n =6),moderate disability (n =8),severe disability (n =3) and vegetative status (n =5) and death (n =3).Conclusion Different operative strategies may be applied for severe brain contusion and laceration according to their clinical manifestations,CT findings and ICP values.And the efficacies are improved by operative strategies based on the principles of ICP control,prevention of secondary injury and brain function preservation.