| 摘要: |
| ［摘要］ 目的 探讨颅脑损伤开颅术后非手术区迟发性颅内血肿（DTICH）的危险因素。方法 回顾分析21例颅脑损伤术后发生非手术区DTICH病例的临床资料。结果 发生在颅脑损伤开颅手术后的非手术区颅内血肿占同期的7.5%，86%合并脑挫裂伤，58.6%合并颅骨骨折。首次术前外伤原发性颅内血肿量较大，平均56.4 ml。69%术后去骨瓣减压和常规颅外引流。术后非手术区DTICH发生在72 h内，其中13例为硬膜外血肿，5例为脑内血肿，3例为混合性的硬膜外和硬脑膜下血肿。21例术后DTICH再次手术治疗，恢复良好5例，中度残疾5例，重度残疾6例，死亡5例，病死率为23.8%。结论 颅脑损伤开颅术后非手术区迟发性颅内血肿可能是脑挫裂伤及颅骨骨折的结果，手术导致的颅内压急剧下降是主要危险因素。 |
| 关键词: 迟发性颅内血肿 颅脑损伤 非手术区 开颅手术 |
| DOI：10.3969/j.issn.1674-3806.2011.08.28 |
| 分类号:R 651.1+5 |
| 基金项目: |
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| Investigation of the factors causing delayed traumatic intracranial hematoma in the non-operative area after craniotomy for craniocerebral trauma |
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WEI Fei-wen，CHEN Jiang
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Department of Surgery, the Hospital of Mashan County, Guangxi 530600,China
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| Abstract: |
| ［Abstract］ Objective To investigate the risk factors causing delayed traumatic intracranial hematoma (DTICH) in the non-operative area after craniotomy for craniocerebral trauma. Methods The clinical data of 21 patients with DTICH in the non-operative area, which occurred after craniotomy for craniocerebral trauma, were retrospectively analysed. Results The patients of this group constituted 7. 5% of the patients undergoing craniotomy for craniocerebral trauma during the corresponding period. Eighty-six percent of the patients were accompanied with cerebral contusion-laceration, 58. 6% with skull fracture. The blood volumes of the primarily traumatic intracranial hematomas occurring before the first operation were larger, averaging 56. 4 ml. A bony flap was removed from the skull for decompression and the conventional extracranial drainage was performed in 69% of the patients after the operation. DTICH in the non-operative area, including chiefly extradural hematomas, cerebral contusion-laceration, mixed intracerebral and extradural hematomas, were discovered within 72 h after the operation. All the patients with postoperative DTICH underwent a second craniotomy to eliminate the hematoma. After the operation, 5 patients recovered well, 5 were disabled moderately and 6 seriously, 5 died (23. 8%). Conclusion Cerebral contusion-laceration and skull fracture are the reason about DTICH in the non-operative area. The sharply decreased intracranial pressure resulting from craniotomy for craniocerebral trauma is a major risk factor of DTICH occurring after the operation. |
| Key words: Delayed traumatic intracranial hematoma Craniocerebral trauma Non-operative area Craniotomy |
