新生儿颅内出血外科治疗方法的探讨

Surgical treatment for intracranial hemorrhage in newborn

目的进一步探讨新生儿颅内出血各种类型的治疗和手术方法的选择及其治疗效果。方法新生儿颅内出血17例,年龄最小10 d,最大58 d。出血部位为硬膜下血肿7例,脑内血肿5例(额叶2例,枕叶2例,颞叶1例),硬膜下血肿合并脑内血肿4例,脑内血肿合并脑室出血1例,17例中有9例合并不同程度的蛛网膜下腔出血。采用钻孔置管引流10例,其中硬膜下血肿6例,脑内血肿2例,硬膜下血肿合并脑内血肿2例;采用开颅血肿清除术4例,其中硬膜下血肿1例,为脑疝形成的患儿,脑内血肿2例,其中有1例脑疝形成,硬膜下血肿合并脑内血肿1例;开颅清除血肿加漂浮骨瓣减压3例,其中硬膜下血肿1例,脑内血肿合并脑室出血1例,硬膜下血肿合并脑内血肿1例,3例均有脑疝形成,其中脑疝晚期1例。17例均为急性或亚急性颅内出血。结果17例患儿无一例死亡,5例脑疝形成的患儿也全部成活,术后即瞳孔缩小,神志恢复正常。1例遗留癫痫症状。偏瘫5例中2例完全恢复正常,2例明显好转,1例无明显变化。余均无明显后遗症。结论尽快手术清除血肿,可减轻脑组织的损伤和神经系统后遗症,而对于不同的出血类型要根据出血量、出血部位、出血时间、CT表现及临床症状等综合因素,采取不同的治疗方法和术式,才能获得满意的疗效。

Objective To further explore treatment for all kinds of intracranial hemorrhages in newborn and choice of operative methods and effects. Methods Seventeen intracranial hemorrhage newborn infants were studied. Their ages ranged from 10 d to 58 d. Of them 7 had subdural hematoma, 5 intracerebral hematoma （in 2 it was located in frontal lobe, 2 in occipital lobe and 1 in temporal lobe）, and 4 subdural hematoma plus intracerebral hematoma. The surgical procedure included： ①catheter drainage （n = 10）,including 6 cases of subdural hematoma,2 intracerebral hematoma and 2 subdural hernatoma plus intracerebral hematoma;②evacuation of hematoma （n = 4）, 1 subdural hematoma, 2 intracerebral hematoma, 1 subdural hematoma plus intracerebral hematoma, of the 4 cases,2 with brain henia; ③evacuation of hemotoma and floating bone flap（ n = 3）, 1 subdural hematoma, 1 intracerebral hematoma, 1 intracerehral hematoma plus intraventricular hemorrhage, and all of them with brain henia. Results All the infants were survived. All the 5 infants with brain henia were survived. Two of 5 infants with hemiparalysis completely recovered, 2 improved, 1 had no change, and 1 remained seizures. The rest had satisfactory results. Conclusion Removing the hematoma as soon as possible can reduce the damage of brain tissue and decrease disability rate. Satisfactory results can be get, if different surgical procedures are used for different types of intracranial hemorrhage.