【摘要】 目的探讨重型颅脑损伤开颅大骨瓣减压术后并发硬膜下积液的治疗情况。方法回顾性分析2017年1月至2019年10月在我院神经外科治疗的40例重型颅脑损伤开颅大骨瓣减压术后并发硬膜下积液患者的临床资料,均通过临床表现结合头颅CT检查确诊,其中11例积液较少者行保守治疗;29例占位效应明显者行微创钻颅引流术治疗,其中13例发展为脑积水并更改手术方式,5例行硬膜下-腹腔分流术,3例行脑室-腹腔分流术,3例行骨瓣开颅积液清除术,2例行硬膜下-腹腔分流术+颅骨修补术。分析患者的治疗效果、积液持续时间及预后。结果 40例患者中,37例硬膜下积液减少或消失,其中11例治愈、26例好转,3例无效(2例治疗后硬膜下积液无明显减少,出现颅内感染,最终死亡;1例治疗后硬膜下积液明显减少,但积液复发,病情加重而死亡),治疗总有效率为92.50%。保守治疗患者的积液持续时间为13～45 d,平均(20.4±5.8)d;手术引流或分流患者的积液持续时间为4～7 d,平均(5.8±1.1)d;骨瓣开颅积液清除术、硬膜下-腹腔分流术+颅骨修补术患者的积液持续时间为2～3 d,平均(2.5±0.5)d。37例患者术后随访6个月,GOS评分4分13例、3分22例、2分2例,预后良好率为94.59%。结论重型颅脑损伤开颅大骨瓣减压术后并发硬膜下积液时应根据积液占位情况决定治疗方法,占位少者行保守治疗,占位较大者行手术治疗,患者的总体疗效及预后较好,但也有一定死亡率及重残率。更多还原

【Abstract】 Objective To investigate the treatment of subdural effusion after large decompressive craniectomy for severe craniocerebral injury. Methods The clinical data of 40 patients with subdural effusion after large decompressive craniectomy for severe craniocerebral injury treated in our hospital from January 2017 to October 2019 were retrospectively analyzed, all patients were diagnosed by clinical manifestations combined with cranial CT examination.Among them, 11 cases with less effusion received conservative treatment; 29 cases with obvious space occupying effect were treated with minimally invasive craniotomy and drainage, 13 cases developed into hydrocephalus and changed the operation mode, 5 cases underwent subdural peritoneal shunt, 3 cases underwent ventriculo peritoneal shunt, 3 cases underwent bone flap craniotomy to remove effusion, and 2 cases underwent subdural peritoneal shunt and cranioplasty.The treatment effect, duration of effusion and prognosis of patients were analyzed. Results Among the 40 patients, 37 cases of subdural effusion decreased or disappeared, of which 11 cases cured, 26 cases improved, and 3 cases were ineffective(2 cases had no obvious reduction of subdural effusion after treatment, intracranial infection occurred, and patients died eventually; 1 case of subdural effusion decreased significantly after treatment, but the effusion recurred,then the patiet died because of the condition became heavier), and the total effective rate of treatment was 92.50%. The duration of effusion in patients with conservative treatment was 13-45 d, with an average of(20.4±5.8) d; the duration of effusion in patients with surgical drainage or shunt was 4-7 d, with an average of(5.8±1.1) d; the duration of effusion in patients with bone flap craniotomy to removing effusion, subdural peritoneal shunt and cranioplasty was 2-3 d, with an average of(2.5±0.5) d. Thirty-seven patients were followed up for 6 months, the GOS score was 4 points in 13 cases, 3 points in 22 cases and 2 points in 2 cases, and the good prognosis rate was 94.59%. Conclusion The treatment method of subdural effusion after large decompressive craniectomy for severe craniocerebral injury should be determined based on the amount of effusion occupancy, including conservative treatment for the smaller occupancy and surgical treatment for the larger occupancy. The overall curative effect and prognosis of patients are good, but there is also a certain mortality and severe disability rate.更多还原