CAJ | 학술논문

目的探讨双侧标准外伤大骨瓣开颅术中脑组织医源性损伤的发生机制及防范措施,以降低非预期再次手术率及病死率.方法选择97例具双侧标准外伤大骨瓣开颅手术指征的颅脑损伤患者,采用随机数字表法分为回纳组(41例)和常规组(56例).回纳组术中采用自体骨瓣临时回纳技术,常规组采用双侧标准外伤大骨瓣开颅术.记录两组患者非预期再次手术率及病死率,并进行统计学分析.结果回纳组患者术后非预期再次手术5例(12.20%),其中先手术侧3例(7.3%),后手术侧2例(4.9%);死亡6例(14.6%).常规组患者术后非预期再次手术17例(30.3%),其中先手术侧14例(25.0%),后手术侧3例(5.3%);死亡19例(33.9%).回纳组非预期再次手术率及病死率均显著低于常规组,常规组先手术侧再次手术率较同组后手术侧及回纳组的先手术侧明显为高,差异均有统计学意义(均P<0.05).结论自体骨瓣术中临时回纳能有效减少术中脑组织医源性损伤,显著降低非预期再次手术率及病死率.
목적탐토쌍측표준외상대골판개로술중뇌조직의원성손상적발생궤제급방범조시,이강저비예기재차수술솔급병사솔.방법선택97례구쌍측표준외상대골판개로수술지정적로뇌손상환자,채용수궤수자표법분위회납조(41례)화상규조(56례).회납조술중채용자체골판림시회납기술,상규조채용쌍측표준외상대골판개로술.기록량조환자비예기재차수술솔급병사솔,병진행통계학분석.결과회납조환자술후비예기재차수술5례(12.20%),기중선수술측3례(7.3%),후수술측2례(4.9%);사망6례(14.6%).상규조환자술후비예기재차수술17례(30.3%),기중선수술측14례(25.0%),후수술측3례(5.3%);사망19례(33.9%).회납조비예기재차수술솔급병사솔균현저저우상규조,상규조선수술측재차수술솔교동조후수술측급회납조적선수술측명현위고,차이균유통계학의의(균P<0.05).결론자체골판술중림시회납능유효감소술중뇌조직의원성손상,현저강저비예기재차수술솔급병사솔.
Objective To investigate the cerebral protective effect of intraoperative temporary restoration of autogenous cranial bone flap in bilateral decompressive craniectomy. Methods Ninety seven patients with indication of bilateral decom-pressive craniectomy were divided into two groups randomly: 41 cases in restored group and 56 in routine group. In restored group the autogenous cranial bone flap was temporarily restored during the operation, and in routine group the bilateral decom-pressive craniectomy was undertaken. The unexpected reoperation rate and case fatality rate were analyzed and compared be-tween two groups. Results The outcomes of patients in restored group were:5 underwent unexpected reoperation (12.20%), 3 in prior lateral (7.3%) and 2 in posterior lateral (4.9%);6 deaths (14.6%). The outcomes of patients in routine group were:17 un-derwent unexpected reoperation (30.3%), 14 in prior lateral (25.0%) and 3 in posterior lateral (5.3%);19 deaths (33.9%). The un-expected reoperation rate and case fatality rate in restored group were significantly lower than those in routine group (P<0.05). Prior lateral of routine group had higher unexpected reoperation rate than that of posterior lateral (P<0.05). Conclusion Intraop-erative temporary restoration of autogenous cranial bone flap can effectively reduce iatrogenic injury of cerebral tissuesignificant-ly, and reduce unexpected reoperation rate and case fatality rate in bilateral decompressive craniectomy.