硬脑膜分阶段切开在特重型额颞部颅脑损伤术中的应用

目的研究硬脑膜分阶段切开、分步清除血肿对特重型额颞部颅脑损伤患者的治疗效果，及对急性脑膨出的预防作用。方法2008年2月-2012年6月间我科收治30例特重型额颞部颅脑损伤患者，减压术中采用三阶段切开硬脑膜、分步清除血肿及坏死脑组织。结果术中均未出现难以控制的急性脑膨出；术后头颅CT：硬膜下及脑挫伤区血肿清除理想，脑移位较术前减轻。伤后6个月至1年随访，根据GOS评分评定患者预后：良好／中残（GOS4-5分）4例；重残／植物状态生存（GOS2-3分）12例；死亡（GOS1分）14例，病死率46．7％。结论应用硬脑膜分阶段切开、分步清除血肿及坏死脑组织的方法，能有效防止特重型额颞部颅脑损伤患者减压术中急性脑膨出的发生，降低病死率。

Analysis of the efficacy of the most severe frontal-temporal craniocerebral injury with gradual removal of hematoma by sequential dural incision during surgery

Objective Aim to evaluate the effect of gradual removal of hematoma by sequential dural incision on patients with the most severe frontal-temporal craniocerebral injury and the prevention of acute encephalocele during the decompressive craniotomy. Methods Sequential dural incision was applied to 30 patients with the most severe frontal-temporal eraniocerebral injury during the decompressive craniotomy in our department between 2008.2 and 2012.6. Results No uncontrollable acute encephalocele occurred during surgery. CT after operation shows improvement of brain displacement and clear removal of subdural hematoma and cerebral hematoma, at 6 to 12 month follow-up, GOS was used to evaluate the prognosis of the eases. 4 patients were good or moderately disabled with 4 to 5 points. 12 who got 2 to 3 points were severely disabled or in a vegetative situation. 14 died in this group. Conclusion The technique of gradual removal of hematoma by sequential dural incision on patients with the most severe frontal-temporal cranioeerebral injury can prevent acute encephaloeele effectively,reduces the mortality and improves the therapeutie effect of the patients.