外伤后急性半球脑肿胀的手术治疗

目的 探讨外伤后急性大脑半球肿胀（ACHS）的治疗效果以及影响疗效的主要因素.方法 对38例外伤后急性半球脑肿胀病人的资料进行回顾性分析.所有患者均接受了去骨瓣减压手术.结果 大骨瓣减压术后,CT影像显示脑中线结构无明显移位、环池结构清晰.术后6个月按GOS评分标准评估：良好14例（占36.8%）、中残9例（占23.7%）、重残5例（占13.2%）、植物生存4例（占10.5%）、死亡6例（占15.8%）.结论 早期去骨瓣减压手术可改善患者预后,而脑肿胀合并急性硬膜下血肿、手术后出血性脑挫伤处血肿量明显增加以及出现创伤后大面积脑梗死的患者预后较差.

Operation for acute cerebral hemispheric swelling after traumatic brain injury

Objectives To investigate effects and factors associated with clinical outcomes of decompressive hemicraniectomy on patients with acute cerebral hemispheric swelling （ACHS）after traumatic brain injury. Methods The clinical data of 38 patients with ACHS after head trauma, who underwent a decompressive craniectomy were analyzed retrospectively. All data available on patients＇age, Glasgow Coma Scale score （GCS）, pupil size and reaction and CT scans were collected and analyzed. The patients＇ outcomes were evaluated by the Glasgow Outcome Scale （GOS）. Results Decompressive craniectomy reduced the midline shift in all patients with unilateral diffuse brain edema;in the remaining, it ameliorated the basal cisterns effacement. According to GOS on follow-up of 6 months, 14 patients （36.8%） recovered well, 9 （23.7%） moderately disabled, 5 （ 13.2% ） severely disabled,4 （ 10.5% ） vegetatively survived and 6 （ 15.8% ） died. Conclusions The early surgery of decompressive craniectomy is an effective way to improve patients outcoms. The acute subdural hematoma associated with brain swelling, the volume of hemorrhagic contusion expansion significantly following hemicraniectomy and the large area posttraumatic cerebral infarction are strongly associated with poor outcome.